Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery:A systematic review with metaanalysis

作     者：Jean Jacques Noubiap Brice Nouthe Ying Tung Sia Marco Spaziano 

作者机构：Centre for Heart Rhythm DisordersThe University of AdelaideAdelaide 5000South AustraliaAustralia Department of MedicineUniversity of British ColumbiaVancouver V6T 1W5Canada Department of MedicineRegional Trois-Rivières Hospital(CIUSSS-MCQ)Trois-Rivières 5000Canada Department of CardiologyMcGill University Health CentreMontréal QC H4A 3J1Canada 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2022年第14卷第4期

页      面：250-259页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Vasoplegia Cardiac surgery Coronary artery bypass graft Angiotensin converting enzyme inhibitors 

摘      要：BACKGROUND Vasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system(RAS)blockers[angiotensin converting enzyme inhibitors(ACEIs)and angiotensin receptor blockers(ARB)]is still *** To update and summarize data on the effect of preoperative use of RAS blockers on incident *** All published studies from MEDLINE,EMBASE,and Web of Science providing relevant data through January 13,2021 were identified.A random-effects metaanalysis method was used to pool estimates,and post-cardiac surgery shock was differentiated from *** Ten studies reporting on a pooled population of 15672 patients(none looking at ARBs exclusively)were included in the *** were case-control *** of ACEIs was associated with an increased risk of vasoplegia[pooled adjusted odds ratio(Aor)of 2.06,95%CI:1.45-2.93]and increased inotropic/vasopressor support requirement(pooled aOR 1.19,95%CI:1.10-1.29).Post-cardiac surgery shock was increased in the presence of left ventricular dysfunction(pooled aOR 2.32,95%CI:1.60-3.36;I249%)but not increased by the use of beta blockers(pooled aOR 0.78,95%CI:0.36-1.69;I277%).Two randomized control trials(RCTs),not eligible for the meta-analysis,did not show an association between continuation of RAS blockers and *** Preoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in *** absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.