Expanding the indication for sutureless aortic valve replacement to patients with mitral disease.

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conflicting 3 : In particular, landiolol, a selective b 1blocker with a 4-min half-life, showed detrimental effects on cerebral oxygenation when therapy is aimed at attaining a certain heart rate. 4 Moreover, another study revealed that enteral metoprolol (a selective b 1-blocker) therapy in patients with septic myocardial depression leads to a significant increase in the required doses of catecholamines. 5 In our opinion, further experimental and clinical research is required to elucidate a valid strategy to target the hyperactivation of the sympathetic nervous system during septic shock. This clearly includes not only b-adrenergic receptors but also a-adrenergic receptors (eg, the a 2-adrenergic receptor), as there are increasing experimental data showing that a 2-adrenergic blockade attenuates septic cardiomyopathy by increasing cardiac norepinephrine concentration and inhibiting cardiac endothelial activation. 6 We were encouraged to perform a concise review including treatment advances based on randomized controlled clinical trials, and thus our review focused on treatment strategies with existing robust clinical evidence. As mentioned in our article, we agree with Drs Orso and Copetti that adequately powered and well-performed randomized controlled trials are necessary to clarify the debatable role of b-blockers in septic cardiomyopathy therapy.

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