Intrapericardial drug delivery: pharmacologic properties and long-term safety in swine

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

“…18 The second reason supporting the topical use of antifibrinolytics is based on the observation that the pericardium acts as a natural barrier that minimizes the rate of systemic absorption and side effects of pharmacological agents applied locally into the pericardial cavity. In this regard, experimental studies by Waxman et al 15 and Kolletis et al 14 showed that the intrapericardial delivery of different types of medications in animals (e.g. digitalis, antiarrhythmic agents, nitric oxide) could lead to desirable therapeutic effects with little or no systemic absorption (or toxicity).…”

“…12 Due to the natural barrier properties of the pericardium, which prevents free diffusion of substances, recent experimental studies have shown that local application of different medications into the pericardial cavity can lead to desirable therapeutic efficacy without significant systemic absorption. [13][14][15] In light of these findings, topical application of antifibrinolytics may be an effective and safe pharmacological strategy to minimize blood loss in cardiac surgery. [16][17][18][19][20][21] This systematic review aims to evaluate the best available evidence about the safety and efficacy of the topical use of antifibrinolytic drugs to reduce postoperative blood loss and transfusion requirements in adult patients having on-pump cardiac surgery.…”

Randomised comparison of growth hormone versus IGF-1 on early post-myocardial infarction ventricular remodelling in rats

“…Second, the method of drug delivery chosen in the present study, namely by direct intramyocardial punctures, may not represent a real local delivery, because a significant proportion of proteins may have entered the systemic circulation. More sophisticated drug delivery systems, such as intrapericardial delivery [40] or via a biomaterial scaffold [41], may be associated with more prominent results.…”

Localized Drug Delivery for Cardiothoracic Surgery

“…In other words, such local delivery allows for higher doses of this class of agents to be safely administered to control focally the heart rhythm-an application that could be especially applied during cardiothoracic surgery. To date, the intrapericardial delivery of antiarrhythmic agents has been attempted with numerous agents, e.g., esmolol [63], solatol [65], atenolol [65], ibutalide [66], procainamide [67], [68], digoxin [67], amiodarone [69], arachadonic acid [70], nitroglycerin [57] and L-arginine [71] have all been shown to have electrophysiological effects when delivered to the pericardial space in various animal models. Additionally, in those studies that also measured plasma concentrations, there was minimal crossover of the delivered agent into the bloodstream [67][68][69] To date, despite these reported successes in treating arrhythmias in various animal models, the clinical practice of intrapericardial (IP) delivery is not widely employed.…”