title: Adapting to living with a mechanical aortic heart valve: a phenomenographic study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. kjersti.oterhals@helse-bergen.no
authors.forename: Kjersti
authors.initials: K
authors.lastname: Oterhals
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Nordrehaug
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
authors.forename: Tone M
authors.initials: TM
authors.lastname: Norekvål
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D055815:Young Adult
keywords: adaptation; aortic stenosis; cardiac nursing; mechanical prosthesis; phenomenographic analysis; qualitative method