Rao Eteesha
Newcastle University Medical School Newcastle-Upon-Tyne UK.
Clin Case Rep. 2025 Apr 7;13(4):e70410. doi: 10.1002/ccr3.70410. eCollection 2025 Apr.
With over 5000 successful aortic valve replacements (AVR) carried out across the UK, thousands of patients leave hospital physiologically and physically treated, with the expectation that they will gradually integrate back into their day-to-day routines. However, the psychological burden associated with the surgery is often underestimated. We describe a 55-year-old male attending a cardiology clinic with severe aortic regurgitation due to thickened aortic valve cusps. He was admitted for 9 days at a specialist hospital 2 h away from his home for AVR, requiring him to leave his wife for whom he is the sole carer. The burden of caregiving, coupled with the stress of surgery and post-operative recovery, led to heightened psychological distress, impeding his recovery. The burden and stress were measured using the Short Form-36 (SF-36) health survey and self-reported daily ratings of pain, physical discomfort, weakness, depression, and irritability. While most recover physically after open-heart surgery, psychological distress can slow overall recovery. Stress and inadequate recovery are linked through physiological mechanisms, including heightened inflammatory responses and impaired immune function. The patient's well-being and remission progression were assessed through follow-up clinic visits and SF-36 questionnaires. Importantly, these were not reported back to the GP upon hospital discharge, representing a gap in holistic recovery management. The discussion elaborates on the necessity of integrating psychological assessment in AVR recovery and how stress pathways affect long-term outcomes. Recovery should not be focused solely on the physical aspects of surgery but also on the psychological and social impacts.
在英国,已经成功进行了5000多例主动脉瓣置换术(AVR),数千名患者在生理和身体上得到治疗后出院,期望能逐渐重新融入日常生活。然而,与手术相关的心理负担往往被低估。我们描述了一名55岁男性,因主动脉瓣叶增厚导致严重主动脉瓣反流,前往心脏病诊所就诊。他在离家2小时路程的一家专科医院住院9天进行AVR手术,这使得他不得不离开他作为唯一照顾者的妻子。照顾负担,再加上手术压力和术后恢复压力,导致心理痛苦加剧,阻碍了他的康复。使用简短健康调查问卷(SF - 36)以及自我报告的每日疼痛、身体不适、虚弱、抑郁和易怒评分来衡量负担和压力。虽然大多数患者在心脏直视手术后身体会康复,但心理痛苦会减缓整体康复进程。压力和恢复不足通过生理机制相互关联,包括炎症反应增强和免疫功能受损。通过随访门诊和SF - 36问卷对患者的幸福感和病情缓解进展进行评估。重要的是,这些结果在出院时并未反馈给全科医生,这代表了整体康复管理中的一个缺口。讨论阐述了在AVR康复中纳入心理评估的必要性以及压力途径如何影响长期结果。康复不应仅关注手术的身体方面,还应关注心理和社会影响。