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DOI: 10.1055/s-0035-1544456
Hemodynamic Differences in Three Aortic Bioprostheses and the Correlation to Early BNP Alterations as a Marker for Myocardial Recovery
Objective: Brain Natriuretic Peptide(BNP) has been proven valuable and predictive regarding myocardial recovery in patients undergoing aortic valve replacement (AVR). Literature reveals early BNP increase after AVR followed by gradual decrease within months. This study analyses whether hemodynamic performance of three different aortic bioprostheses results in different early postoperative BNP alterations.
Methods: We compared postoperative peak and mean pressure gradients (ppeak, pmean) of patients undergoing AVR using SJM Trifecta™(SJT) versus Edwards Perimount™(EP) and Medtronic HancockII™(MH) prosthesis and analyzed the correlation to alterations of mean pre-/ postoperative(day7) BNP values.
Results: Between 6/2013 to 9/2014 135 patients (nSJT = 51, nEP = 46, nMH = 38) (mean age 70.6 ± 0.8 years, 74.8% male) were included. Postoperative peak gradients in SJT, EP versus MH were 15.4 ± 0.9, 20.7 ± 0.9 and 23.9 ± 1.4 mm Hg (pSJT-EP/SJT-MH/EP-MH < 0.0001), mean gradients were 8.4 ± 0.5 mm Hg, 11.5 ± 0.7 and 12.9 ± 0.8 mm Hg (pSJT-EP = 0.0004; pSJT-MH < 0.0001; pEP-MH = ns). Preoperative mean BNP levels were: SJT 504.1 ± 202; EP 325.7 ± 70.63 and MH 706.8 ± 175.5 and dropped postoperatively to 456,6 ± 38.66 in the Trifecta group, whereas levels increased in EP and MH to 394.1 ± 47.71 and 721.9 ± 113.7 (pSJT-EP = ns;pSJT-MH = 0.0141; pEP-MH = 0.0073).
Conclusion: This study demonstrates superior early hemodynamic performance of the SJM Trifecta™ compared with the Edwards Perimount™ and Medtronic HancockII™ aortic prosthesis.
The favorable pressure gradients in the Trifecta group seem to translate into early BNP decrease as a marker for improved myocardial recovery. As not yet significant larger series has to be awaited to confirm our preliminary results.