Résumé
Methods@#LSS patients who underwent decompression surgery with or without fusion were included. Clinical outcomes were measured before surgery and 6 months postoperatively using the Zurich Claudication Questionnaire (ZCQ); Visual Analog Scale (VAS) of low back pain, leg pain, and leg numbness; Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale were used to evaluate psychological status before surgery. Patients were classified as satisfied or dissatisfied with surgery based on a ZCQ satisfaction subscale cutoff score of 2.5. @*Results@#The satisfied and dissatisfied groups contained 128 and 29 patients, respectively. Six months postoperatively, outcome scores for the dissatisfied group were unchanged or worse than preoperative scores (p>0.05). Multivariate logistic regression analysis showed significant associations between dissatisfaction and preoperative low back pain VAS score ≥ median (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.10–0.74; p=0.01), preoperative mental health SF-36 score ≥ median (OR, 0.26; 95% CI, 0.08–0.89; p=0.03), and preoperative anxiety HADS score ≥ median (OR, 3.95; 95% CI, 1.16–13.46; p=0.03). @*Conclusions@#Preoperative less severe low back pain, lower mental health, and higher anxiety are associated with patient dissatisfaction with lumbar surgery, not depression, pain catastrophizing, or fear-avoidance beliefs. Pre- and postoperative psychological status should be assessed carefully and managed appropriately.
Résumé
Preservation of subvalvular mitral apparatus and maintenance of continuity between structures and annulus is recognized, and widely accepted as a significant factor for avoiding impairment to ventricular function and preventing left ventricular rupture during mitral valve replacement. However, we encountered a patient who developed posteromedial papillary muscle rupture following chordal sparing mitral valve replacement. The patient was a 67-year-old man who underwent mitral valve replacement with a porcine bioprosthesis 29M for acute mitral valve insufficiency due to several spontaneous chordal ruptures. The subvalvular apparatus of both leaflets was retained, the center of the anterior leaflet was excised elliptically, and the entire posterior leaflet was preserved. Although his postoperative course was uneventful, the transthoracic echocardiogram showed a floating structure prolapsing through the aortic valve in the left ventricle synchronizing with the cardiac cycle. The severed papillary muscle was removed successfully via an aortotomy through the native aortic valve on the 57th day after the first surgery. The patient recovered with no events. Surgeons should consider avoiding an excessive tension on the preserved chordae and delivering a cardioplegia sufficiently and uniformly during mitral valve replacement.