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Recent research has produced findings which indicate a significant role for psychological factors in determining the nature of a patient's acute response to open heart surgery. In the present study a consecutive series of 68 adult open heart surgical patients were considered for psychological evaluation with the Minnesota Multiphasic Personality Inventory (MMPI) during the week preceding each operation.After determining that the 54 patients who were able to provide pre-operative psychological data were not a unique subsample of the originally referred patients, several parameters were analyzed in relation to survival of the surgical procedures. The factors of age, sex and pre-operative cardiac disability were not found to be significantly related to operative mortality in the present patient sample.Separate analysis of the MMPI scale scores for male and female patients revealed distinct group differences in personality characteristics, both with respect to each other and in relation to survival of the operation. Agitation was found to be more pronounced among male patients who did not survive the open heart operation than among those who did. This agitation was felt to be indicative of a basic vulnerability to stress without effective psychological coping mechanisms. Female patients who did not survive surgery were characterized by increased physical complaints and emotional overcontrol and appeared less accepting of any emotional component related to their physical disabilities than were the surviving female patients. These findings were also compared with previous reports based both on clinical interviews and on responses on standard psychological tests.Comparative analyses were also done between the groups of male and female open heart patients who survived the surgical procedures and matched groups of medical patients who did not have diagnoses directly involving the cardiac system or receive any operative procedures. These comparisons revealed high similarity between the groups for both male and female patients and were felt to further distinguish the personality features noted among the nonsurvivors of the open heart operation.The results were felt to indicate that attention to preoperative symptoms of severe psychiatric disturbance, symptoms of pronounced anxiety among male patients and symptoms of emotional overcontrol among female patients may help reduce mortality in open heart surgery.