Abstract
Aim. To describe how patients adapt to living with a mechanical aortic heart
valve.
Background. Aortic valve replacement with a mechanical prosthesis is preferred
for patients with life expectancy of more than 10 years as they are more durable
than bioprosthetic valves. Mechanical valves have some disadvantages, such as
higher risk of thrombosis and embolism, increased risk of bleeding related to
lifelong oral anticoagulation treatment and noise from the valve.
Design. An explorative design with a phenomenographic approach was
employed.
Methods. An explorative design with a phenomenographic approach was applied.
Interviews were conducted over 4 months during 2010–2011 with 20 strategically
sampled patients, aged 24–74 years having undergone aortic valve replacement
with mechanical prosthesis during the last 10 years.
Findings. Patients adapted to living with a mechanical aortic heart valve in four
ways: ‘The competent patient’ wanted to stay in control of his/her life. ‘The
adjusted patient’ considered the implications of having a mechanical aortic valve
as part of his/her daily life. ‘The unaware patient’ was not aware of warfarin–
diet–medication interactions. ‘The worried patient’ was bothered with the oral
anticoagulation and annoyed by the sound of the valve. Patients moved between
the different ways of adapting.
Conclusions. The oral anticoagulation therapy was considered the most
troublesome consequence, but also the sound of the valve was difficult to accept.
Patient counselling and adequate follow-up can make patients with mechanical
aortic heart valves more confident and competent to manage their own health.
We recommend that patients should participate in a rehabilitation programme
following cardiac surgery.
Keywords: adaptation, aortic stenosis, cardiac nursing, mechanical prosthesis,
phenomenographic analysis, qualitative method