Renin-angiotensin system blockers in cardiac surgery

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.