title: Renin-angiotensin system blockers in cardiac surgery.
abstract: Major complications associated with cardiac surgery are still common and carry great prognostic significance. β-Blockers, statins, antiplatelets, and renin-angiotensin system (RAS) blockers are current medical interventions to prevent cardiovascular complications in cardiac surgery. Renin-angiotensin system blockers include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and antialdosterones. Several lines of evidence support the cardioprotective effects of RAS blockers: they reduce ischemic events and improve outcome in heart failure independently of their effect on heart function and blood pressure. Moreover, early RAS blocker administration has remarkable survival and heart function benefits in patients with acute myocardial infarction. Nevertheless, perioperative studies on the effects of RAS blockers remain few and inconclusive. Results from clinical trials and observational studies are conflicting, and they raise more questions than answers. Further studies are needed to examine whether RAS blockers reduce mortality and major complications in patients undergoing cardiac surgery. In this review, we discuss the use of RAS blockers in the setting of cardiac surgery, underlying the potential benefits in reducing postoperative complications.
authors: Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: Antonio.mangieri@gmail.com.
authors: Antonio
authors: A
authors: Mangieri
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012084:Renin-Angiotensin System
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: ACE inhibitors; Acute kidney injury; Atrial fibrillation; Cardiac surgery