primary goal of all forms of therapy is not just prolonging life, but
improving the quality of life, has forced analysis of what constitutes
quality of life, a concept whose structure pervades all walks of life
and eludes definition. Global well being, happiness, morale, vitality,
fullness of social life, and satisfaction must be integrated and
assessed for the effects of the disease and the therapy, in the context
of specific personality traits, attitudes to life, family situation, and
socio-economic and political freedom. A growing inter- est in research
on this subject has led to a clearer understanding of the components
which come to determine quality of a patient's life, and how they can be
measured in a reproducible manner so that valid comparisons can be made.
Keeping these recommendations of analysing quality of life within the
context of patients who have undergone open heart surgery, it seemed
appro- priate to me to separate the influence of various forms of open
heart surgery into five aspects of life which can comprehensively
reflect the quality of life outcome of the operation. These five
'components' are (1) Physiological state, which summarises the
traditionally reported incidence of operative mortality and morbidity,
objectively and subjectively measured physical ca- pacity, and the
residual symptoms, treatment and long-term survival. (2) Intellectual
functioning relates to the psychoneurolgocial deficit in memory,
reasoning or judgement because of cerebral microembolism and hypo-
perfusion during cardiopulmonary bypass.