Bayer-Topilsky Tali, Suri Rakesh M, Topilsky Yan, Marmor Yariv N, Trenerry Max R, Antiel Ryan M, Mahoney Douglas W, Schaff Hartzell V, Enriquez-Sarano Maurice
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; JDC-Myers-Brookdale Institution, Jerusalem, Israel.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2015 Mar;99(3):847-54. doi: 10.1016/j.athoracsur.2014.10.030. Epub 2015 Jan 23.
Severe mitral regurgitation (MR) is associated with frequent alteration of psychoemotional status (PES), with anxiety and stress symptoms related to health-related quality of life (HR-QOL). Yet, it is unknown whether surgical correction of MR leads to improvement or deterioration in PES and HR-QOL.
We prospectively performed comprehensive MR assessment and administered questionnaires assessing PES and HR-QOL in 131 patients (aged 60 years; 75% men) before and 6 months after operation for organic MR and compared them to 62 patients who did not undergo operation for mitral disease and 36 normal controls of similar age assessed with the same methods.
Baseline PES was poorer preoperatively in patients undergoing mitral operation compared with patients who did not undergo mitral operation and normal controls (anxiety and posttraumatic stress [PTS]; both p < 0.01) with poorer physical HR-QOL (p < 0.01). Six months later, all these psychoemotional variables improved (all p ≤ 0.02) in the patients who underwent mitral operation, whereas no change was observed in the other 2 groups (all p > 0.1). Improvement after mitral repair resulted in postoperative normalization of emotional and physical well-being, with similar scores among all groups (all p ≥ 0.4). At 6-month follow-up, no difference in improvement in PES and HR-QOL was noted according to the surgical approach (robotic versus sternotomy, all p ≥ 0.2).
Patients with severe organic MR present with frequent psychoemotional alterations and HR-QOL deterioration, in contrast to patients who do not undergo mitral operation and normal controls. After mitral operation, notable improvement results in normalization of emotional and physical well-being. Quantification of emotional and physical well-being provides important outcome measures in patients with organic MR and uncovers important benefits provided by surgical correction of MR.
严重二尖瓣反流（MR）常伴有心理情绪状态（PES）的频繁改变，焦虑和压力症状与健康相关生活质量（HR-QOL）有关。然而，二尖瓣反流的手术矫正是否会导致PES和HR-QOL的改善或恶化尚不清楚。
我们前瞻性地对131例器质性二尖瓣反流患者（年龄60岁；75%为男性）在手术前和术后6个月进行了全面的二尖瓣反流评估，并使用问卷评估PES和HR-QOL，同时将他们与62例未接受二尖瓣疾病手术的患者以及36例采用相同方法评估的年龄相仿的正常对照者进行比较。
与未接受二尖瓣手术的患者和正常对照者相比，接受二尖瓣手术的患者术前基线PES较差（焦虑和创伤后应激[PTS]；均p<0.01），身体HR-QOL也较差（p<0.01）。6个月后，接受二尖瓣手术的患者所有这些心理情绪变量均有所改善（均p≤0.02），而其他两组未观察到变化（均p>0.1）。二尖瓣修复术后的改善使情绪和身体状况术后恢复正常，所有组的得分相似（均p≥0.4）。在6个月的随访中，根据手术方式（机器人手术与胸骨切开术），PES和HR-QOL的改善情况无差异（均p≥0.2）。
与未接受二尖瓣手术的患者和正常对照者相比，严重器质性二尖瓣反流患者常出现心理情绪改变和HR-QOL恶化。二尖瓣手术后，显著改善可使情绪和身体状况恢复正常。对情绪和身体状况的量化为器质性二尖瓣反流患者提供了重要的预后指标，并揭示了二尖瓣反流手术矫正所带来的重要益处。
