In cardiac surgery patients with renal dysfunction, febuxostat reduced uric acid earlier than allopurinol, had a stronger renoprotective effect than allopurinol, and also had superior antioxidant and anti-inflammatory effects.

Low-dose infusion of landiolol hydrochloride prevented atrial fibrillation after cardiac surgery in patients with cardiac dysfunction and was safe, with no effect on blood pressure. This intravenous β-blocker seems useful for perioperative management of cardiac surgical patients with left ventricular dysfunction.

Direct oral anticoagulants have recently been recommended for non-valvular atrial fibrillation, but have rarely been studied in the field of cardiac surgery. We prospectively investigated the safety of edoxaban, a novel oral anticoagulant, for use in cardiac surgery patients with postoperative atrial fibrillation (POAF), which is the most common complication of cardiac surgery and can lead to stroke. The subjects were adult cardiac surgery patients with POAF who received oral edoxaban for 2 months in an open-label pilot study. The primary endpoint was cerebrovascular/bleeding events up to 2 months, while the secondary endpoints were hemoglobin, prothrombin time, and activated partial thromboplastin time. There were no cerebrovascular or bleeding events during edoxaban treatment and the test drug was not discontinued by any patient. There was no macroscopic hematuria and hemoglobin did not decrease, being significantly higher than the baseline level after 2 months. The prothrombin time was significantly prolonged from 1 week to 2 months and the activated partial thromboplastin time was significantly prolonged from 1 day to 2 months. Echocardiography detected pericardial effusion in 1 patient, but hemoglobin did not decrease and the effusion improved with diuretic therapy. In conclusion, despite the limited sample size of this pilot study, it was demonstrated that edoxaban does not induce bleeding in patients with POAF after cardiac surgery, suggesting that it is safe to perform a large-scale efficacy study of edoxaban as anticoagulant therapy for POAF.

IntroductionEight (8) angiotensin II receptor blockers (ARBs) are currently available for clinical use internationally. Losartan was launched in Japan in 1998 and seven other ARBs have been marketed since then. Large-scale clinical studies have demonstrated various benefits of ARBs, including both antihypertensive and organ protective effects. Each of the eight ARBs also has its own unique characteristics. 1) Azilsartan was released in 2012 and is the newest ARB in Japan. Basic research comparing its antihypertensive effect with other ARBs has shown a stronger effect of azilsartan, but sufficient clinical data have not yet been obtained. 2) An in vitro study demonstrated that azilsartan had a higher affinity for the angiotensin II type 1 (AT1) receptor than other ARBs and that its dissociation from the receptor was slower. It was also reported that azilsartan demonstrates strong and persistent blocking of the actions of angiotensin II. Background: Angiotensin II receptor blockers (ARBs) have been widely used to treat hypertension and large-scale clinical studies have shown various benefits. In this study, we compared olmesartan with azilsartan, the newest ARB. Methods: The subjects were outpatients who were clinically stable after cardiac surgery. Sixty patients were randomized to receive either azilsartan or olmesartan for 1 year and were switched to the other drug for the following 1 year. The primary endpoints were the levels of plasma renin activity, angiotensin II, and aldosterone. Results: Home blood pressure exceeded 140/90 mmHg and additional antihypertensive medication was administered to 12 patients (20 episodes) in the azilsartan group versus 4 patients (4 episodes) in the olmesartan group, with the number being significantly higher in the azilsartan group. After 1 year of treatment, both angiotensin II and aldosterone levels were significantly lower in the olmesartan group than the azilsartan group. Left ventricular mass index was also significantly lower in the olmesartan group than the azilsartan group. Conclusion: This study showed that olmesartan reduces angiotensin II and aldosterone levels more effectively than azilsartan. Accordingly, it may be effective in patients with increased renin-angiotensin-aldosterone system activity after cardiac surgery or patients with severe cardiac hypertrophy.

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Background: Infection of the percutaneous site of a ventricular assist device (VAD) is a challenging complication. We report our experience with crystal violet Solbase (Nihon University crystal violet method) for prevention of driveline or cannula infections in VAD patients. Patients and Methods: The crystal violet method was used in 10 patients (prophylaxis in nine and treatment in one). Eight patients had an extracorporeal VAD (Nipro) and two had an implantable VAD (Heart Mate II). Results: The infection-free period was 4-623 days (mean: 144.2 ± 222.9 days). All eight patients with an extracorporeal VAD died, while the two patients with an implantable VAD (Heart Mate II) survived. Infection was improved in a patient with MRSA, and the results of bacteriological examination were always negative in the patients receiving prophylaxis. The two patients with an implantable VAD had no infection for 2 and 20 months after implantation. Conclusion: These findings suggest that the Nihon University crystal violet method is effective for prevention and treatment of driveline or cannula infections in patients with a VAD.

Driveline and cannula site infections are still a frequent adverse event in patients with a ventricular assist device (VAD), and it is important to treat and prevent them because the spread of local infection may cause sepsis in some cases. We report our experience with a patient in whom infection of the NIPRO LVAD cannula site after implantation of an extracorporeal VAD was controlled by treatment with crystal violet Solbase (Nihon University crystal violet method).

We previously performed a randomized controlled trial of carperitide (Daiichi-Sankyo Pharmaceutical Inc, Tokyo, Japan; Asubio Pharmaceuticals, Inc, Kobe, Japan), which inhibits the renin-angiotensin-aldosterone system (RAAS) and has strong natriuretic activity. We found that carperitide compensated for the adverse effects of extracorporeal circulation and inhibited left ventricular remodeling. [8][9][10][11] In the Nihon University working group study of low-dose HANP Infusion Therapy during cardiac surgery (NU-HIT) for Left Ventricular Dysfunction study, carperitide reduced the incidence of POAF, 8 but an antiarrhythmic effect of carperitide has not been reported in patients with heart failure and the mechanisms involved were unclear. Accordingly, the present study (NU-HIT trial for POAF) was performed to further evaluate the effect of carperitide on POAF and investigate factors related to AF.© 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Occurrence of atrial fibrillation after cardiac surgery is associated with long-term mortality. We investigated whether infusion of human atrial natriuretic peptide (carperitide) could prevent postoperative atrial fibrillation. Methods and Results-A total of 668 patients who underwent isolated coronary artery bypass grafting were randomized to receive infusion of carperitide or physiological saline from the initiation of cardiopulmonary bypass. Patients were monitored continuously for 1 week after surgery to detect atrial fibrillation. The risk factors were investigated by Cox proportional hazard model. Postoperative atrial fibrillation occurred in 41 of 335 patients (12.2%) from the carperitide group versus 110 of 333 patients (32.7%) from the placebo group (P<0.0001). Postoperative levels of angiotensin-II, aldosterone, creatine kinase MB isoenzyme, human heart fatty acid-binding protein, and brain natriuretic peptide were all significantly lower in the carperitide group. The risk factors for postoperative atrial fibrillation by the Cox proportional hazard model were an age ≥70 years, emergency surgery, preoperative aldosterone level >150 ng/mL, preoperative nonuse of angiotensin receptor antagonists, preoperative use of calcium antagonists, postoperative nonuse of β-blockers, postoperative nonuse of aldosterone blockers, and nonuse of carperitide. Conclusions-Perioperative Methods Study ProtocolThe NU-HIT trial for POAF was a randomized, double-blind, placebo-controlled study that enrolled patients undergoing isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Patients who had cardiogenic shock, sinus bradycardia (≤50 per minutes at rest), atrioventricular block, hypothyroidism/hyperthyroidism, a history of AF or other arrhythmia, repeat CABG, and off-pump or on-pump beating CABG were excluded. Subjects were randomized preoperatively by the envelope method to the carperitide group receiving infusion of carperitide from initiation of CPB or the placebo group receiving physiological saline. In Ja...