Impact of renin-angiotensin system blocker after aortic valve replacement-a systematic review and meta-analysis

Data reporting the impact of renin-angiotensin system inhibitor (RASi) after aortic valve replacement (AVR) is controversy.

The PubMed database was systematically searched for studies reporting the mortality and hazard ratios (HRs) of RASi following surgical and transcatheter AVR (SAVR, TAVR). Random-effects model was used when the I2 statistic was more than 50% and its P value was less than 0.05, otherwise, the fixed-effects model was conducted.

Nine articles incorporating 33,063 patients were eligible. Patients having the description of RASi were associated with lower all-cause mortality at 30 days (OR, 0.80, 95% CI, 0.69 to 0.94), 1 year (OR, 0.75, 95% CI, 0.69 to 0.81) and beyond 1 year (OR, 0.52, 95% CI, 0.38 to 0.73) after AVR. Consistently, patients with RASi had lower risk for all-cause mortality (HR, 0.87, 95% CI, 0.84 to 0.91) beyond 1 year following AVR albeit adjusting confounders. Interestingly, beneficial effect of RASi was still observed in patients with preserved ejection fraction following TAVR (HR, 0.90, 95% CI, 0.87 to 0.94). In addition, patients taking RASi had lower cardiovascular mortality than those patients without RASi after TAVR (30 days, OR, 0.63, 95% CI, 0.44 to 0.90; 1 year, OR, 0.60, 95% CI, 0.50 to 0.73; beyond 1 year, OR, 0.63, 95% CI, 0.54 to 0.74).

Patients with RASi exhibited better short- and long-term survival following AVR compared to those patients without RASi, which warranted further studies to support such findings.