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In patients with mitral regurgitation, surgery improves well-being
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Compared with patients who do not undergo surgery, patients with organic mitral regurgitation who undergo surgery experience significant improvements in emotional and physical well-being, regardless of the existence of preoperative symptoms, according to recent findings.
“Mitral regurgitation is frequent, with thoroughly analyzed objective outcomes such as [HF] and survival, but little focus on patient well-being,” the researchers wrote. “This gap in knowledge can now be addressed using well-standardized tools for health-related quality of life and psychoemotional status, defined by distress and traumatic stress–related symptoms.”
In the prospective study, researchers compared 131 patients with mitral regurgitation who underwent mitral repair surgery with 62 patients with mitral regurgitation who did not require immediate surgery and 36 people of comparable age without mitral disease. The group that underwent surgery was evaluated for psychoemotional status and health-related quality of life (HR-QOL) before surgery and at 6 months after surgery; the other groups also were evaluated for these measures at baseline and at 6-month follow-up.
The psychoemotional status evaluation included assessment of distress, using Hospital Anxiety and Depression Scale and posttraumatic stress (PTS) as measured by a modified PTS Disorder Checklist Civilian Version scale.
HR-QOL was evaluated using Short Form (SF)-12, an abbreviated version of SF-36, which included a physical component summary and a mental component summary.
The researchers found that compared with patients who did not undergo surgery and normal controls, patients who underwent mitral operation had poorer preoperative psychoemotional status (anxiety and PTS; both P < .01), with poorer HR-QOL (P < .01). At 6-month follow-up, however, patients who underwent surgery demonstrated improvements in all psychoemotional variables (all P ≤ .02) while the other two groups demonstrated no changes (all P > .1). These postoperative improvements resulted in the normalization of emotional and physical well-being, with comparable scores noted across all groups (all P ≥ .4). Moreover, at the 6-month follow-up, there was no difference in psychoemotional status or HR-QOL improvements based on the surgical approach used (robotic vs. sternotomy, all P ≥ .2).
In a related commentary, Daniel J. Ullyot, MD, of the University of California, San Francisco, said these findings suggest that severe mitral regurgitation has a negative effect on mental health that can be improved by surgery.
“Further studies are required to confirm these findings, to ascertain whether improved mental health is sustained after operation beyond 6 months, and to discover whether the favorable impact of surgery is the result of restoring normal valve function or some other effect of surgical intervention,” Ullyot wrote.
Disclosure: The researchers and Ullyot report no relevant financial disclosures.
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