Increased ET-1 and endothelin receptor-A levels have been identified in patients with native AS,24 and endothelin A and B receptors are located on the leaflets’ tips and surface.25 There is a transient increase following myocardial damage after AVR and a concomitant diastolic dysfunction26; however, this does not persist, and it decreases in conjunction with brain natriuretic peptide after improvement of the ventricular function due to decreased LV afterload.27 In our work, the ET-1 level was similar between mechanical or non-functional biological prostheses. Here, NPPB is linked to aortic stenosis.