IMPACT OF MECHANICAL HEART-VALVE PROSTHESIS SOUND ON PATIENTS QUALITY-OF-LIFE

Background. The ''click'' sound of mechanical heart valve prostheses h as been recognized as a disturbing factor for some patients after mech anical heart valve implantation. The factors determining the extent of disturbance remain controversial. Methods. Ninety-five unmatched pati ents with six different valve types were examined (Duromedics-Edwards, Bjork-Shiley, St. Jude Medical, Medtronic, CarboMedics, and Omnicarbo n), including 12 patients with double-valve replacement. Three groups (Bjork-Shiley, Duromedics-Edwards, and St. Jude Medical) were comparab le in size. All patients were examined and interviewed, a hearing rest was performed, and valve sounds were analyzed. Sound transmission was evaluated. Results. The loudest valve was the Duromedics-Edwards pros thesis (mean, 84.2 dB[A] impulse) and the St. Jude Medical was the qui etest (mean, 73.5 dB[A] impulse). This ranking was independent of pati ent variables and valve position. Discomfort level correlated with hea ring loss and loudness of the valve. Patients desiring a quieter valve had better hearing, had louder valve sounds, felt disturbed by the so und, had partners who felt disturbed, and were receiving coumarin for anticoagulation. Sound was transmitted predominantly by air conduction . The frequency analysis to identify different valves was unsatisfacto ry, but louder frequencies did correspond with hearing-impaired patien ts' audiograms. Conclusions. Our results emphasize the need for valve design changes, preoperative education about the sound, and inclusion of routine hearing tests into the preoperative workup.