Clinical outcomes associated with the use of sacubitril/valsartan in the perioperative period of patients undergoing cardiac surgery: a systematic review

Introduction and objectives

Sacubitril/valsartan (SV) is recommended in patients with heart failure, especially in reduced ejection fraction. So far, the safety of its use in perioperative cardiac surgery is uncertain but given its mechanism of action and possible blood pressure lowering effect, some guidelines recommend discontinuation, without clear evidence. This systematic review aims to assess clinical outcomes of use SV in the perioperative period compared with never having used it or its withdrawal.

Methods

Systematic literature review in MedLine, Cochrane, EMBASE and LILACs of studies published in English and Spanish. We included randomized clinical trials and non-randomized studies evaluating adult patients undergoing cardiac surgery that compared the use of SV up to the day of surgery versus stopping or not starting it prior to the procedure. In-hospital and 30-day mortality, length of stay in general ward and intensive care unit stay, orotracheal intubation, postoperative vasoplegia and need for renal replacement therapy were assessed. Quality was assessed using the ROBINS tool.

Results

Three non-randomized studies were included, one single-arm. There were fewer cases of in-hospital and 30-day mortality in the group in which SV was not discontinued, with no statistically significant difference. There was no difference in length of hospital or intensive care unit stay, orotracheal intubation, need for renal replacement therapy, or frequency of postoperative vasoplegia (OR, 0.77; 95%CI, 0.23–2.98).

Conclusions

The current evidence is scarce and of low quality so a recommendation regarding the use of SV prior to cardiac surgery cannot be generated, further studies are required.