Published online Apr 26, 2022. doi: 10.4330/wjc.v14.i4.250
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
Processing time: 134 Days and 16.1 Hours
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.
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.
To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia.
The authors performed a systematic review of the literature, and summarized available data using a random-effects meta-analysis.
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) .
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.
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.