الفهرس 
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Abstract
Valvular heart disease is one of the most common cardiovascular diseases, affecting over 100 million patients worldwide; this number is increasing due to the growing elderly population, which leads to significant public health issues. The prevalence of aortic valve disease is increasing, with a reported incidence of approximately 3–4% in the adult population. Aortic valve disease is the most prevalent valvular disease requiring valve replacement. In Egypt, cardiovascular disease (CVD) has been the leading cause of premature death since the 1990s. In 2017, CVD accounted for 46.2% of the overall mortality in Egypt.
The surgical indications for aortic valve replacement (AVR) are based on evidence levels, and the conventional procedure for AVR is full median sternotomy. This method offers advantages such as the complete exposure of the heart and ascending aorta, reduced surgical time, and a mortality rate ranging from 2% to 5%.
To enhance the patient’s quality of life and avert surgical complications, appropriate training is imperative to ensure the patient’s compliance with post-surgical medical advice and lifestyle modification. Thus, it is imperative to provide patients with comprehensive guidelines to promote self-care and avoid further complications.
Awareness of self-care refers to individual responsibilities for healthy lifestyle behaviours required for functioning, staying fit, maintaining good physical and mental health, and meeting social and psychological needs. Positive self-care behaviors include: lifestyle modifications (e.g., dietary changes and exercise), managing therapy (i.e., adhering to prescribed treatments), effectively utilizing healthcare services and appropriately responding to symptoms and problems.
The present study aimed at assessing patients` awareness of healthcare related to post-aortic valve replacement surgery, by assessing patients` knowledge, attitude and reported practices about aortic valve replacement surgery and care post-surgery.
The study was conducted using a descriptive design at the outpatient clinic of the cardiovascular hospital affiliated with Ain Shams University hospitals. The subjects of the present study included 100 patients of both sexes who had recently undergone aortic valve replacement surgery. The total number of patients was 179 representing the attendance rate in the year 2021 who had recently undergone aortic valve replacement surgery.
The study utilized a structured interviewing questionnaire sheet comprising four parts. The first part of the questionnaire collected socio-demographic data of the patients such as (as age, gender, education level, occupation, working hours per day, marital status, and residence). The second part recorded the patient’s medical history including past and present medical conditions. The third part assessed the patient’s knowledge about aortic valve surgery care post aortic valve replacement surgery, including heart anatomy and diseases related to the aortic valve, aortic valve surgery, and post-surgical care. The fourth part evaluated patient-repoted practices regarding care post aortic valve replacement surgery, including diet regimen, rest and daily activities, personal hygiene, surgical wound care, and adherence to medication and doctor’s instructions. The second tool was used to assess patients` attitudes related to care post aortic valve replacement surgery, which included 33 items; 10 items for physical activities after surgery, 9 items for social aspects (work and daily routine activities), 7 items for psychological aspects and 7 items for spiritual health.
The main study findings were as follows: The mean age of the sample was (50.93 ± 7.933) years; as 50% of the studied sample was male and 50% of them were female. Moreover, 35% of them were illiterate. Also, more than three-quarters (77%) had another chronic disease, 93.5% and 28.5% of them suffered from hypertension and diabetes mellitus, respectively. Moreover, 56% of the patients reported having family members suffering from cardiac diseases, 41.1% and 35.7% of them reported having father/mother and uncle/aunt cardiac diseases. In terms of complaint history, 46% of patients reported complaining from 1 year to less than two years before surgery, and 87% of them discovered having valve disease by seeking medical advice after experiencing symptoms. Furthermore, 50% of them were smokers and only 4% had medication sensitivity. Regarding patient’s total knowledge about aortic valve surgery care post aortic valve replacement surgery, 59% of them had total satisfactory knowledge, while 41% of them had total unsatisfactory knowledge. Concerning reported practices regarding aortic valve surgery care post aortic valve replacement surgery, only 32% of patients had total healthy practices, while 68% of them had total unhealthy practices. In terms of patients` reported attitudes related to care post aortic valve replacement surgery, only 8% of the studied patients had a total positive attitude, and 96% of them had a total negative attitude.
Concerning the relation between the studied variables, there was a statistically significant relation between the studied patients` total knowledge about aortic valve replacement surgery and their age, educational level, occupation and residence with p< 0.05 respectively. Moreover, there was a statistically significant relation between the studied patients` total practice about aortic valve replacement surgery, their occupation and working hours per day with p< 0.05 respectively. Also, there was a statistically significant relation between the studied patients` total attitude about aortic valve replacement surgery and their marital status with p< 0.05 respectively.
In addition, there was a statistically significant positive correlation between the total knowledge of the studied patients and their total attitude with (r=0.350, p=0.000**), respectively. Moreover, there was a statistically significant positive correlation between the total practice of the studied patients and their total attitude (r=0.480, p=0.000**).
In conclusion, more than half of the studied patients had total unsatisfactory knowledge, more than two thirds of them had total unhealthy practices, and the vast majority of them had total negative attitudes regarding aortic valve surgery care post aortic valve replacement surgery. Additionally, there was a significant positive correlation between the total knowledge of the studied patients and their total attitude. However, there was no statistically significant correlation between total knowledge and total practice of the studied patients. Moreover, there was a statistically significant positive correlation between the total practice of the studied patients and their total attitude.
It is recommended that a health education program is needed for patients with aortic valve replacement surgery to improve their knowledge, practice and attitude regarding their self-care post-surgery. Additionally, patients should be given a booklet as a handout for patients containing basic and important instructions for aortic valve replacement surgery patients when leaving the hospital.
Also, it is recommended to provide rehabilitation programs for all patients who had undergone aortic valve replacement surgery, to prevent the complications of heart attacks. Moreover, integrating qualitative research to explore perceived self-care post-surgery may generate new knowledge and increase the depth of understanding.