Noubiap JJ, Nouthe B, Sia YT, Spaziano M. Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis. World J Cardiol 2022; 14(4): 250-259 [PMID: 35582469 DOI: 10.4330/wjc.v14.i4.250]
Corresponding Author of This Article
Jean Jacques Noubiap, MD, MMed, Academic Research, Senior Editor, Statistician, Centre for Heart Rhythm Disorders, The University of Adelaide, Port Road, Adelaide 5000, South Australia, Australia. noubiapjj@yahoo.fr
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2022; 14(4): 250-259 Published online Apr 26, 2022. doi: 10.4330/wjc.v14.i4.250
Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis
Jean Jacques Noubiap, Brice Nouthe, Ying Tung Sia, Marco Spaziano
Jean Jacques Noubiap, Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide 5000, South Australia, Australia
Brice Nouthe, Department of Medicine, University of British Columbia, Vancouver V6T 1W5, Canada
Ying Tung Sia, Department of Medicine, Regional Trois-Rivières Hospital (CIUSSS-MCQ), Trois-Rivières 5000, Canada
Marco Spaziano, Department of Cardiology, McGill University Health Centre, Montréal QC H4A 3J1, Canada
Author contributions: Nouthe B, Noubiap JJ, Spaziano M and Sia YT contributed to the conception and design; Nouthe B, Noubiap JJ, and Spaziano M contributed to the search strategy; Nouthe B and Noubiap JJ contributed to the studies selection, data analysis and synthesis, data interpretation; Noubiap JJ contributed to the manuscript drafting; Nouthe B, Noubiap JJ, Spaziano M and Sia YT contributed to the manuscript revision, and approval of the final manuscript.
Conflict-of-interest statement: All authors report no disclosures.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jean Jacques Noubiap, MD, MMed, Academic Research, Senior Editor, Statistician, Centre for Heart Rhythm Disorders, The University of Adelaide, Port Road, Adelaide 5000, South Australia, Australia. noubiapjj@yahoo.fr
Received: December 5, 2021 Peer-review started: December 5, 2021 First decision: January 25, 2022 Revised: February 9, 2022 Accepted: March 27, 2022 Article in press: March 27, 2022 Published online: April 26, 2022
ARTICLE HIGHLIGHTS
Research background
Vasoplegia is a common complication of cardiac surgery. The use of some medications prior to surgery is thought to contribute to inappropriate vasodilatation in vasoplegia. The causal relationship between preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] between vasoplegia is unclear.
Research motivation
If perioperative use of RAS blockers is associated with vasoplegia, withholding these medications in patients undergoing cardiac surgery might help preventing vasoplegia after cardiac surgery.
Research objectives
To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia.
Research methods
The authors performed a systematic review of the literature, and summarized available data using a random-effects meta-analysis.
Research results
Ten studies reported on a pooled population of 15672 patients were included in the meta-analysis. Use of ACEIs was associated with an increased risk of vasoplegia and increased inotropic/vasopressor support requirement. Left ventricular dysfunuction increased the risk of post-cardiac surgery shock. There was no association between continuation of RAS blockers and vasoplegia in the two included randomized control trials (RCTs) .
Research conclusions
Preoperative continuation of ACEIs is associated with an increased risk of the use of inotropic support postoperatively and vasoplegia in observational studies but not in RCTs.
Research perspectives
Further studies are needed to clarify the relationship between perioperative use of RAS blockers and vasoplegia after cardiac surgery. Such studies should use a consensus definition of vasoplegia and conduct appropriate perioperative cardiovascular monitoring.
