The cardioprotective effect of intralipid in decreasing the ischemic insults during off-pump coronary artery revascularization

Abstract

Background Off pump coronary artery revascularization (OPCAB) surgeries have benefits over the conventional on pump cardiac surgery, because it avoids the trauma caused by cardiopulmonary bypass (CPB) and minimize aortic manipulation. However, some disadvantages of OPCAB include the concern of ineffective coronary revascularization. Some drugs have shown the ability to protect the myocardium in different studies, by different methods. The usage of intralipid has been shown to make a better functional recovery of the cardiac muscles and help to decrease the myocardial infarct size, it shortens the action potential time, which show polyunsaturated fatty acids diets mechanism as an antiarrhythmic drug, and are associated with low incidence of coronary artery disease. Methods We divided patients into two groups according to the randomization envelopes: intralipid group (group A) received 1.5 ml/kg intralipid 20% through central venous line after sternotomy over 1 h and during infusion, blood pressure, heart rate, and temperature were monitored all through the infusion time. Control group (group B) received normal saline 0.9% in the same volume over the same duration. Results This study showed that infusion of 1.5 ml/kg intralipid after sternotomy in off pump coronary artery revascularization given as preconditioning agent improve the myocardial ischemia reperfusion injury, decrease the need for high doses of nor adrenaline infusion after revascularization, earlier normalization in troponin levels starting 24 h after surgery and higher values of cardiac index were measured in ICU using PICCO. Conclusions This study showed the benefits of infusion of 1.5 ml/kg of intralipid after sternotomy, in preconditioning during OPCABG. Preconditioning with intralipid proved to decrease reperfusion injury in myocardium expressed by improvement in cardiac functions (EF and cardiac index) and normalization of specific cardiac marker (cardiac troponin I).

Myocardial Metabolism in Heart Failure

“…More recently, the cardioprotective role of substrate manipulation has been explored in surgical post-coronary revascularisation. Intralipid infusion post-sternotomy as a pre-conditioning agent was associated with reduced need for high-dose inotropic support, earlier normalisation of serum troponin levels, and higher values of cardiac index measured by invasive cardiac monitoring [ 59 ]. These effects are believed to be mediated by phosphorylation of glycogen synthase kinase-3β (GSK-3β) and delaying of the opening of the mitochondrial permeability transition pore (mPTP) associated with cellular apoptosis [ 60 ].…”