Before the Incision, the Heart Already Knows: Why Preoperative Distress Matters?

10.1055/s-0042-1758824

I read with interest the article by Buschmann et al examining whether preoperative mental distress predicts early cardiac surgical outcomes.[1] The authors report a negative finding for short-term endpoints in their cohort. However, in a study currently under publication, we observed that patients presenting with pronounced preoperative anxiety or depressive symptoms tended to experience a more turbulent postoperative course, characterized by slower recovery and prolonged convalescence and more complications. These impressions are supported by multiple systematic reviews and meta-analyses showing that depression and anxiety around the time of cardiac surgery are associated with worse cardiovascular outcomes.[2] Biologically, the heart is not merely an end-pump organ of hemodynamics but a richly innervated organ with an intrinsic cardiac nervous system that communicates bidirectionally with the central nervous system. The “little brain” in the heart modulates autonomic tone, inflammation, and arrhythmogenic substrate, and may mediate how emotional states influence cardiac physiology.[2] [3] Across many cultural and philosophical traditions, the heart is viewed as a center of insight, wisdom, and decision-making. Cardiac efferent signals influence emotional processing, autonomic balance, and higher-order judgments, supporting the concept of a “thinking heart” or the intellectual heart whose responses shape how patients perceive stress and vulnerability before major surgery and affect quality of life postoperatively.[4] [5] [6] Investigators are encouraged to use validated, quantitative psychiatric measures at multiple perioperative time points and integrate biomarkers of inflammation and autonomic function to test mechanistic links. Clinically, systematic preoperative screening and early psychosocial interventions deserve evaluation as part of comprehensive cardiac surgical care.

Contributor's Statement

K.A. contributed to conceptualization, data curation, formal analysis, investigation, visualization, writing–original draft, writing–review and editing.

Publication History

Received: 16 December 2025

Accepted: 15 January 2026

Article published online:
28 January 2026

• References

• 1 Buschmann K, Wiltink J, Ghazy A. et al. Does mental distress predict cardiac surgical outcome?. Thorac Cardiovasc Surg 2025; 73 (07) 529-535
• 2 Flaherty LB, Wood T, Cheng A, Khan AR. Pre-existing psychological depression confers increased risk of adverse cardiovascular outcomes following cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2017; 154 (05) 1578-1586.e1
• 3 Goh FQ, Tan BYQ, Yeo LLL, Sia CH. The heart-brain axis: Key concepts in neurocardiology. Cardiol Discov 2025; 5 (02) 162-177
• 4 Alzahrani AA, AlAssiri AK, Al-Ebrahim KE, Ganbou ZT, Alsudais MM, Khafagy AM. Impact of clinical and sociodemographic factors on quality of life following coronary artery bypass grafting: A mixed-methods study. Cureus 2024; 16 (03) e56781
• 5 Al-Ebrahim KE, Albishri SA, Alotaibi SW. et al. The quality of life in patients with valve prosthesis after undergoing surgery for valvular heart diseases. Cureus 2023; 15 (08) e43030
• 6 Almramhi K, Aljehani M, Bamuflih M. et al. Frequency and risk factors of unplanned 30-day readmission after open heart surgeries: A retrospective study in a tertiary care center. Heart Surg Forum 2022; 25 (04) E608-E615