Con: ACE Inhibitors Should Be Stopped Prior to Cardiovascular Surgery

Disque, Andrew; Neelankavil, Jacques

doi:10.1053/j.jvca.2016.01.016

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…RAAS blockers are mainly used to treat hypertension and heart failure but also have a protective effect against the development of nephropathy through their inherent properties, which are not directly related to their effects on lowering blood pressure [135,136]. Nevertheless, the use of RAAS blockers in some patients is fraught with controversy [136][137][138][139]. The role of newly developed direct renin inhibitors in cardiac surgical patients is uncertain, and data are currently lacking.…”

Section: Renin-angiotensin-aldosterone System Inhibitorsmentioning

confidence: 99%

“…It has been debated whether ACEIs should be discontinued before CABG [136,137,140]. The Ischemia Management With Accupril Post Bypass Graft Via Inhibition of the coNverting Enzyme (IMAGINE) study did not show any benefit of quinapril compared to placebo initiated early within 7 days of surgery; greater rates of morbidity and mortality have been observed at 3 months in the quinapril group [141].…”

Section: Preoperative Discontinuationmentioning

confidence: 99%

See 1 more Smart Citation

2017 EACTS Guidelines on perioperative medication in adult cardiac surgery

Sousa-Uva¹,

Head²,

Milojevic³

et al. 2017

European Journal of Cardio-Thoracic Surgery

329

224

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Disclaimer 2017: The EACTS Guidelines represent the views of the EACTS and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The EACTS is not responsible in the event of any contradiction, discrepancy and/or ambiguity between these Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS Guidelines do not in any way whatsoever override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do EACTS Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Section: Renin-angiotensin-aldosterone System Inhibitorsmentioning

confidence: 99%

Section: Preoperative Discontinuationmentioning

confidence: 99%

2017 EACTS Guidelines on perioperative medication in adult cardiac surgery

Sousa-Uva¹,

Head²,

Milojevic³

et al. 2017

European Journal of Cardio-Thoracic Surgery

329

224

View full text Add to dashboard Cite

show abstract

“…The association between angiotensin converting enzyme inhibitors (ACEI) and post-operative hypotension was first recognized more than two decades ago in adults ( 6 , 7 ). In a previous study Ajuba-Iwuji et al reported that preoperative ACE inhibitor and ARB use in pediatric patients undergoing cardiac surgery did not significantly increase the incidence of hypotension after induction of anesthesia and did not significantly increase vasoconstrictor requirements upon weaning from CPB; however, patients on ACE inhibitor/ARB therapy tended to have a higher VIS than patients in the control group ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment

Pandya

Alphonso

et al. 2018

Front. Cardiovasc. Med.

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Prolonged postoperative vasoplegia is known to occur following cardiac surgery in patients on chronic angiotensin II receptor blocker (ARB) treatment in adults. The perioperative management of these drugs in the pediatric population is not well described and here we would like to highlight this fact. While ARBs are increasingly used in children and adolescents with hypertension, there is lack of data to guide optimal pre-surgical management in the pediatric age group. We report two cases of prolonged vasoplegia following cardiopulmonary bypass occurring in adolescent patients on chronic ARB therapy and the importance of cessation of these drugs preoperatively.

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“…Thus, it has been demonstrated that the long-term use of ACEIs and ARBs reduces morbidity and mortality in patients with diabetes, cardiovascular and kidney diseases. Nevertheless, its application remains controversial in cardiac surgery patients ( 147 , 148 ).…”

Section: Myocardial Homeostasis In Current Cardiac Surgery Settingsmentioning

confidence: 99%

The spectrum of myocardial homeostasis mechanisms in the settings of cardiac surgery procedures (Review)

et al. 2017

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Classic cardiac surgery, determined through the function of cardiopulmonary bypass machine and myocardial cardioplegic arrest, represents the most controlled scenario for cardiomyocyte homeostatic disturbances due to systemic inflammatory response and myocardial reperfusion injury. An increasing number of studies have demonstrated that myocardial cell homeostasis in cardiac surgery procedures is a sequence of molecularly interrelated and overlapping mechanisms in the form of apoptosis, autophagy and necrosis, which are activated by a plethora of induced inflammatory mediators and gene-related signaling pathways. In this study, we outline the molecular mechanisms of the cardiomyocyte adaptive homeostatic process and the associated clinical implications, in the settings of classic cardiac surgery procedures.

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Con: ACE Inhibitors Should Be Stopped Prior to Cardiovascular Surgery

Cited by 19 publications

References 17 publications

2017 EACTS Guidelines on perioperative medication in adult cardiac surgery

2017 EACTS Guidelines on perioperative medication in adult cardiac surgery

Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment

The spectrum of myocardial homeostasis mechanisms in the settings of cardiac surgery procedures (Review)

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