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

Aim. To conduct a systematic review and meta-analysis of studies to determine the efficacy and safety of using sacubitril/valsartan combination in the perioperative period in adult patients undergoing cardiac surgery. Material and methods. The search for studies was carried out in the PubMed (MEDLINE), Google Scholar and Cochrane library databases. The inclusion criteria for studies were the use of sacubitril/valsartan combination in the perioperative period in adult patients undergoing open-heart cardiac surgery with adequately presented baseline parameters and clinical outcome data. Results. Seven studies from 459 publications were selected for this systematic review. The total number of patients was 707, of which 452 were men (63,9%). Two studies described the use of angiotensin receptor-neprilysin inhibitors (ARNI) in the implantation of left ventricular assist device or heart transplant. A meta-analysis was performed on these studies, which demonstrated that the incidence of vasoplegic syndrome after these operations did not differ significantly between the ARNI group and the control group (relative risk 0,69; 95% confidence interval: 0,40-2,30; p=0,92). Also, two studies considered the results of therapy during coronary bypass grafting, while three studies — during the valve defect treatment. All studies demonstrated improvement in certain clinical parameters (ejection fraction and left ventricular (LV) size, cardiac index, natriuretic peptide levels, 6-minute walk test, etc.), as well as the safety of ARNI administration (no significant renal dysfunction and hypotension), including its early initiation after cardiac surgery. Conclusion. ARNI administration in the perioperative period has been studied in a limited and heterogeneous series of studies with small sample sizes, which are devoted to surgical treatment of end-stage heart failure, coronary artery disease and valve defects. Sacubitril/valsartan combination therapy demonstrated safety and efficacy in all groups considered. Further large controlled clinical trials are required to formulate reliable recommendations regarding the use of ARNI in the perioperative period.