The Impact of Angiotensin-Modulating Medications on Outcomes of Thoracic Endovascular Aortic Repair in Patients with Thoracic Aortic Aneurysms.
Academic Article
Overview
abstract
OBJECTIVES: Withholding renin-angiotensin-aldosterone system (RAAS) antagonists prior to surgery has been suggested in previous studies on non-vascular procedures due to their potential contribution to postoperative comorbidities. Evidence on the role of RAAS modulation is limited in vascular surgery literature. This study investigates the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on outcomes of thoracic endovascular aortic repair (TEVAR) in patients with thoracic aortic aneurysms (TAA). METHODS: Data from the Vascular Quality Initiative (VQI) was queried for all patients who underwent TEVAR for TAA between January 2014 and 2024. Patients below the age of 18 and those with connective tissue disorders were excluded. Patients who required further open thoracotomy were also excluded from the analysis. Our primary outcomes were 30-day and 1-year mortality. Our secondary outcomes were postoperative myocardial infarction, dysrhythmia, number of RBC pack transfusions needed, same-day extubation, and prolonged length of hospital stay. Multivariate logistic regression analyzed short-term outcomes and Kaplan-Meier survival, and the log-rank test analyzed one-year survival. RESULTS: Among 7,839 eligible patients, those receiving preoperative ACEI/ARB were more likely to be male, non-Black, hypertensive, diabetic, have congestive heart failure, a history of coronary artery disease, some degree of kidney dysfunction, and better preoperative functional status. Thirty-day, and 1-year mortality rates were similar between groups (all p > 0.05). There were no significant differences in rates of postoperative MI, packed RBC transfusion, or dysrhythmia. However, preoperative ACEI/ARB use was independently associated with higher odds of same-day extubation (OR = 1.38, 95% CI: 1.07-1.77; p = 0.014) and reduced risk of prolonged hospital stay (OR = 0.88, 95% CI: 0.80-0.97; p = 0.010). CONCLUSIONS: Despite several previous studies reporting adverse effects of preoperative ACEI/ARBs on surgical outcomes, this multi-institutional study found that patients receiving ACEI/ARBs preoperatively were more likely to be extubated on the same day of the operation and had shorter hospital length of stays. There were no differences in other postoperative outcomes or survival up to one year. This study suggests continuing the use of ACEI/ARBs in patients undergoing TEVAR.
