Perioperative Utilization of Angiotensin Receptor-neprilysin Inhibitor in Patients with Heart Failure with Reduced Ejection Fraction Undergoing Coronary Artery Bypass Grafting-a Narrative Review

Overview

Journal Indian J Thorac Cardiovasc Surg

Publisher Springer

Date 2025 Feb 20

PMID 39975880

Authors

Manoj Durairaj

Kaushal Pandey

Rajneesh Malhotra

Ritwik Raj Bhuyan

Vijyant Devenraj

Arunkumar Ulaganathan

Abhay Singh Walia

Mohd Azam Haseen

Debasish Sahu

Madhav Kumar

Sangram Keshari Behera

Atul Kumar Gupta

Sanjay Kumar

Chandan Ray Mohapatra

Sanjay Jain

Ambrish Khatod

Tushar Kumar

Neeraj Kumar Sharma

Amrutraj Nerlikar

Soumya Ranjan Mahapatra

Lingraj Nath

Affiliations

Soon will be listed here.

Abstract

Heart failure with reduced ejection fraction (HFrEF) is frequently observed in patients undergoing coronary artery bypass grafting (CABG), and it significantly increases the risk of postoperative death while exerting a crucial influence on the recovery process following the surgical intervention. HFrEF is one of the prevalent risk factors for early readmission in patients who underwent CABG. Angiotensin receptor-neprilysin inhibitor (ARNI) has been recognized as a critical medical therapy in the management of HFrEF; however, its efficacy and safety have yet to be corroborated in the context of CABG. Therefore, this opinion document developed by a group of cardiothoracic and vascular surgeons in India focuses on the utilization of ARNI for patients with HFrEF, including those undergoing or having undergone CABG. These opinions based on clinical experience include perioperative use of ARNI; postoperative initiation of ARNI; strategies for addressing challenges such as hyperkalemia, hypotension, and renal dysfunction; and initiation of other foundational medical therapies in HFrEF management in the context of CABG.

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