Renin-Angiotensin System Blockade in Aortic Stenosis: Implications Before and After Aortic Valve Replacement

• Published in: Journal of the American Heart Association Vol. 9; no. 18; p. e016911
• Main Authors: Goel, Sachin S, Kleiman, Neal S, Zoghbi, William A, Reardon, Michael J, Kapadia, Samir R
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 15.09.2020; Wiley
• Subjects: aortic stenosis; aortic valve replacement; Aortic Valve Stenosis - etiology; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Contemporary Review; Contemporary Reviews; Heart Valve Prosthesis Implantation - adverse effects; Humans; Renin-Angiotensin System - drug effects; Renin-Angiotensin System - physiology; renin‐angiotensin system; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Ventricular Remodeling - drug effects; transcatheter aortic valve replacement; aortic stenosis; aortic valve replacement; renin‐angiotensin system
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.016911

Aortic stenosis (AS) is a common valvular heart disease in the aging population that is characterized by a variable period of asymptomatic phase before development of symptoms and severe AS. Mortality and morbidity is substantial even after aortic valve replacement, in part related to persistent left ventricular hypertrophy, diastolic dysfunction, and heart failure. Renin-angiotensin system (RAS) blockade therapy is associated with modulation of adverse left ventricular remodeling, reduction in myocardial hypertrophy, and fibrosis, resulting in clinical improvements in patients with congestive heart failure There are emerging data to suggest benefit of RAS blockade in patients with AS before and after AVR with regard to potentially slower progression of aortic valve calcification, left ventricular mass and survival benefit in favor of RAS blockade group before AVR, and also survival benefit in patients after AVR. We review the available data to understand the role of RAS blockade before AVR and in patients undergoing surgical AVR and transcatheter AVR. There are significant survival advantages of RAS inhibition in patients with AS undergoing surgical AVR or transcatheter AVR. On the basis of existing literature, adequately powered randomized trials are needed to evaluate the role of RAS inhibition in patients with AS.