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Adapting to living with a mechanical aortic heart valve: a phenomenographic study

Authors

  • Kjersti Oterhals MSc RN,

    Nurse Researcher, Corresponding author
    • Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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  • Bengt Fridlund PhD RNT,

    Professor
    1. School of Health Sciences, Jönköping University, Sweden
    2. Institute of Nursing, Bergen University College, Norway
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  • Jan Erik Nordrehaug MD PhD,

    Professor
    1. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
    2. Institute of Medicine, University of Bergen, Norway
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  • Rune Haaverstad MD PhD,

    Professor
    1. Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
    2. Institute of Surgery, University of Bergen, Norway
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  • Tone M. Norekvål MSc PhD RN

    Nurse Researcher Associate Professor
    1. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
    2. Institute of Nursing, Bergen University College, Norway
    3. Institute of Medicine, University of Bergen, Norway
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Correspondence to K. Oterhals:

e-mail: kjersti.oterhals@helse-bergen.no

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.

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