Perioperative therapy with Sacubitril/Valsartan combination in adult patients undergoing cardiac surgery: A systematic review and meta-analysis

Objective: This study aims to conduct a systematic review and meta-analysis of research to determine the efficacy and safety of using the sacubitril/valsartan combination during the perioperative period for adult patients undergoing cardiac surgical interventions.

Materials and Methods: The search for studies was conducted in the PubMed (MEDLINE), Google Scholar, and Cochrane Library databases. Inclusion criteria for studies included the use of the sacubitril/valsartan combination in the perioperative period for adult patients undergoing open-heart surgeries, with adequately presented baseline characteristics and clinical outcome data.

Results: A total of seven studies were selected for this systematic review from 459 publications. The total number of patients was 707, of which 452 were men (63.9%). Two studies described the use of ARNI during after left ventricular assist device implantation or heart transplantation. A meta-analysis of these studies demonstrated that the incidence of vasoplegia syndrome after these operations did not significantly differ between the ARNI group and the control group (RR 0.69; 95% CI: 0.40–2.30; p=0.92). Two studies also examined therapy outcomes during coronary bypass surgery, while three studies focused on valve pathology correction. All studies showed improvements in various clinical indicators (ejection fraction and left ventricle sizes, cardiac index, levels of natriuretic peptides, six-minute walk test, etc.), as well as the safety of ARNI administration (no significant deterioration in kidney function or hypotension), including its early initiation after cardiac surgery.

Conclusions: The use of ARNI in the perioperative period has been studied in a limited and heterogeneous series of works with small sample sizes, focusing on surgical correction of end-stage heart failure, coronary artery disease, and valve pathology. Therapy with the sacubitril/valsartan combination demonstrated safety and efficacy across all examined groups. To formulate reliable recommendations regarding ARNI use in the perioperative period, further large controlled clinical trials are required.

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