Psychoemotional status improves after surgery for mitral regurgitation

Last Updated: 2015-03-05

By Will Boggs MD

NEW YORK (Reuters Health) - Anxiety and posttraumatic stress improve in patients who undergo surgery for mitral regurgitation (MR), researchers report.

"The unsuspected alterations of psychoemotional measures and quality of life in patients that often we call asymptomatic the profound effect of mitral surgery in restoring them to normal were surprising," Dr. Maurice Enriquez-Sarano, from Mayo Clinic, Rochester, Minnesota, told Reuters Health by email. "We were initially thinking that the pain of surgery would increase subjective 'suffering,' so the 'mental healing' effect of the surgical correction of the MR was surprising."

About a quarter of patients with organic MR have poor psychoemotional status (PES), elevated anxiety, and traumatic stress levels that are not correlated with higher MR severity or its objective consequences.

Dr. Enriquez-Sarano's team measured PES and health-related quality of life (HR-QOL) by validated questionnaires in 131 patients who underwent mitral operation, 62 patients with MR who did not undergo mitral operation, and 36 controls at baseline and six months later.

Patients who did not undergo operation and normal controls did not differ in PES scores at baseline or at follow-up, according to the January 22 Annals of Thoracic Surgery online report.

Patients in the mitral operation group had significantly higher anxiety and posttraumatic stress scores than controls at baseline. These scores improved significantly in the ensuing six months, to the extent that they no longer differed significantly from those of controls.

Patients in the mitral operation group had insignificantly worse anxiety and posttraumatic stress than did patients in the no-operation group at baseline. Only the mitral operation group showed significant improvements for anxiety and posttraumatic stress at six months.

In contrast to the PES results, researchers observed no differences among the three groups at baseline or at follow-up in the mental HR-QOL.

"The old concept of patients asymptomatic may be flawed, as patients may have symptoms or manifestations that we do not measure," Dr. Enriquez-Sarano said. "We only find what we are looking for."

He suggested we routinely assess PES and QOL in these patients. "That would be easy if we can get the questionnaires filled out by patients electronically and stored automatically with their medical record with an automated interpretation," Dr. Enriquez-Sarano said.

He concluded, "If we can fix the cardiac condition, we can also fix the psychoemotional and quality of life issues of the patients. Be proactive in evaluating and treating valve diseases. Do not wait until the last minute when patients are in heart failure."

The Mayo Clinic Foundation funded this study. The authors report no disclosures.

SOURCE: http://bit.ly/1wYbMJx

Ann Thorac Surg 2015.