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CARDIOVASCULAR ANESTHESIA

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures

Elmar Berendes, MD^*, Christoph Schmidt, MD^*, Hugo Van Aken, MD, PhD, FRCA, FANZCA^*, Maike Grosse Hartlage, MD^*, Markus Rothenburger, MD, Stefan Wirtz, MD^*, Hans Heinrich Scheld, MD, Gerhard Brodner, MD^*, and Michael Walter, MD

Klinik und Poliklinik für *Anästhesiologie und Operative Intensivmedizin and Herz–, Thorax- und Gefäßchirurgie, University of Münster, Münster, Germany; and Department of Biochemistry, Southwestern Medical Center at Dallas, Dallas, Texas

Address correspondence and reprint requests to Elmar Berendes, MD, Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany. Address e-mail to berenel{at}uni-muenster.de

This study was performed to determine the secretion pattern and prognostic value of A-type (ANP) and B-type (BNP) natriuretic peptide in patients undergoing cardiac surgical procedures. We measured ANP and BNP in patients undergoing coronary artery bypass grafting (CABG) with (n = 28) or without (n = 32) ventricular dysfunction and in patients undergoing mitral (n = 21) or aortic (n = 24) valve replacement, respectively. Postoperative mortality was recorded up to 730 days after operation. ANP, but not BNP, concentrations were closely associated with volume reloading of the heart after aortic cross-clamp in all patients. The secretion pattern of BNP during surgery was much less uniform. BNP, but not ANP, concentrations correlated with aortic cross-clamp time (r² = 0.32; P = 0.006) and postoperative troponin I concentrations (r² = 0.22; P = 0.0009) in bypass patients, and preoperative BNP increases were associated with a more frequent postoperative (2-yr) mortality in these patients. Markedly increased preoperative BNP concentrations in mitral (3-fold) and aortic (14-fold) valve disease patients did not further increase during cardiopulmonary surgery. The data suggest that ANP is primarily influenced by intravascular volume reloading of the heart after cross-clamp, whereas the secretion of BNP is related to other factors, such as duration of ischemia and long-term left ventricular pressure and/or excessive intravascular volume. BNP, but not ANP, was shown to be a mortality risk predictor in patients undergoing CABG.

IMPLICATIONS: A-type natriuretic peptide is primarily influenced by volume reloading of the heart after cross-clamp, whereas the secretion of B-type natriuretic peptide (BNP) is related to the duration of ischemia and long-term left ventricular pressure and/or volume overload. Preoperative BNP, but not postoperative BNP, concentrations predict long-term outcome after coronary artery bypass grafting.

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