Postoperative hemodynamic stability of patients treated with the sacubritil-valsartan combination in cardiac surgery

BACKGROUND: The Sacubitril-Valsartan combination (SVC) has been gaining an important role in the treatment of heart failure with reduced ejection fraction. We aimed to evaluate the immediate postoperative hemodynamic profile of patients usually treated with the SVC and undergoing elective cardiac surgery. MATERIALS AND METHODS: This single-center retrospective study was conducted from January 2022 to March 2024 in cardiac surgery. All consecutive patients treated with SVC were compared to unexposed patients, selected by propensity score matching in a 1:2 ratio. The propensity score was estimated using a logistic regression adjusted for age, sex, creatinine clearance, preoperative critical illness, acute coronary syndrome < 90 days, left ventricular ejection fraction, surgery, and cardiopulmonary bypass time. The primary outcome was the Vasoactive-Inotropic Score (VIS) during the first 24 h postoperatively. RESULTS: We included 28 exposed and 56 non-exposed patients. We found no significant difference in 24-h VIS (Exposed: 21.5 ± 15; Non-exposed: 21.4 ± 18; p = 0.86). We found no significant difference in VIS during the first 5 days, norepinephrine duration, dobutamine duration, lactate change, vascular filling, fluid balance, the occurrence of acute renal failure, duration of mechanical ventilation, and length of stay in intensive care. These results were similar in the subgroup of patients undergoing off-pump coronary artery bypass surgery. However, a difference smaller than 10 VIS points cannot be excluded. CONCLUSION: In this exploratory study in cardiac surgery, preoperative treatment with SVC was not associated with increased vasoplegia and vasoactive drug consumption.