Key result
Intralipid postconditioning prior to aortic cross-unclamping significantly reduced the 72-hour AUC of cTnT by 32.3% (p=0.004) and CK-MB by 26.4% (p=0.0185) compared with control.
Why the study?
Does intravenous intralipid postconditioning reduce myocardial injury in adult patients undergoing elective aortic or mitral valve surgery?
RCT (n=73)
Randomized
Does intravenous intralipid postconditioning reduce myocardial injury in adult patients undergoing elective aortic or mitral valve surgery?
Intralipid postconditioning prior to aortic cross-unclamping significantly reduces biomarker evidence of myocardial injury in patients undergoing valve replacement surgery.
Answers are grounded in this paper and cite their sources.
Supports intralipid postconditioning for myocardial protection in valve surgery; extends experimental data to randomized clinical settings.
OBJECTIVE: This study was conducted to determine whether the administration of intralipid just before aortic cross-unclamping would reduce myocardial injury in patients undergoing valve replacement surgery. METHODS: Seventy-three adult patients, scheduled for elective aortic or mitral valve surgery without significant coronary stenosis (>70%), were randomly assigned to the intralipid postconditioning (ILPC) group (n=37) or control group (n=36): the ILPC group received an intravenous infusion of 20% intralipid (2 mL/kg) just 10 min before aortic cross-unclamping, and the control group received an equivalent volume of normal saline. Serum cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) was measured before surgery and at 4, 12, 24, 48 and 72 hours after surgery. The primary end points were the 72-hour area under the curve (AUC) for cTnT and CK-MB. RESULTS: No significant difference between the ILPC and control arm was observed, including the age, sex or number of aortic versus mitral valves or left ventricular ejection fraction at baseline. The total 72-hour AUC of cTnT and CK-MB in patients assigned to ILPC were significantly reduced by 32.3% (p=0.004) and 26.4% (p=0.0185) compared with control, respectively. None of the treated patients had abnormal blood lipid metabolism, abnormal renal or hepatic function or significant related complications. CONCLUSION: The protective effect of postischaemic administration of intralipid prior to aortic cross-unclamping on reperfusion injury was found when determined by biomarkers of myocardial injury but not by cardiac function or other clinical outcomes in patients undergoing valve replacement surgery. Hence, clinical benefits of this protection need larger clinical trials to confirm. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: ChiCTR-IOR-14005318.
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Zhou et al. (2017) conducted an RCT in Valve replacement surgery (n=73). Intralipid vs. Normal saline was evaluated on 72-hour area under the curve (AUC) for cTnT and CK-MB (32.3% reduction (cTnT) and 26.4% reduction (CK-MB), p=0.004 (cTnT), 0.0185 (CK-MB)). Intralipid postconditioning prior to aortic cross-unclamping significantly reduced the 72-hour AUC of cTnT by 32.3% (p=0.004) and CK-MB by 26.4% (p=0.0185) compared with control.
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