Effect of intralipid on myocardial injury during valve replacement surgery with concomitant radiofrequency ablation: A randomized controlled trial.

Background: This study aimed to evaluate the effect of intralipid postconditioning (ILPC) on myocardial damage in patients undergoing valve replacement surgery with concomitant radiofrequency ablation (RFA) for atrial fibrillation (AF). Methods: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing valve replacement surgery with concomitant RFA. Sixty-nine patients were randomly assigned to ILPC group (n=34) or control group (n=35): ILPC group received an intravenous infusion of 20% intralipid (2mL/kg) just 10minutes before aortic cross-unclamping, and 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 72hours after surgery. The primary endpoints were the 72-hour area under the curve (AUC) for cTnT and CK-MB. Results: The total 72-hour AUC of cTnT (P=.33) and CK-MB (P=.52) were comparable between 2 groups. The left ventricle ejection fraction at discharge (P=.011) was higher in the ILPC group than that in the control group, while the AF recurrence did not differ significantly between 2 groups. Conclusions: There was no observed beneficial effect of ILPC on myocardial injury documented by the cardiac biomarkers in patients undergoing valve replacement surgery with concomitant RFA, and the effect of intralipid against myocardial I/R injury is undetectable within the background of massive biomarker release following ablation owing to localized myocardial necrosis. Besides, there are no other published data about the cardioprotective role of intralipid in patients undergoing this procedure and benefits of this protection need further studies to validate.