Outcomes of mechanical and bioprosthetic surgical valve replacements in egypt: evidence from a narrative review and experts’ survey

Background Selecting between mechanical and bioprosthetic valves depends on multiple clinical and patient-specific criteria. This study aims to compare mechanical and bioprosthetic valve replacement outcomes in Egypt to support evidence-informed decision-making. Methods We conducted a narrative literature review to identify studies reporting outcomes of mechanical and bioprosthetic valve replacements in Egypt. Findings were validated through an expert meeting with cardiothoracic surgeons. To capture real-world practice, an online survey was administered to cardiothoracic surgeons across Egypt. The narrative review and survey results were compared to global data to formulate recommendations on optimizing valve selection in Egypt. We extracted data from 41 eligible studies identified from the literature. Results Findings showed that unlike global data, reoperation rate in Egypt is lower with bioprosthetic valves compared to mechanical valves. Mechanical valves are associated with higher bleeding rates globally and locally. Survival and stroke incidence do not differ significantly between mechanical and bioprosthetic valves. The expert survey was responded to by 128 cardiothoracic surgeons. Experts predominantly used mechanical valves, highlighted age, and anticoagulation eligibility as the main factors influencing valve choice, and showed that longer clinical experience is associated with more tendency to use bioprosthetic valves. Conclusions Valve type selection in Egypt should be individualized and made on a case-by-case basis due to the multiple factors influencing choice and outcomes. To support evidence-based decision-making, more local studies should be conducted, especially for bioprosthetic valves. These factors should be considered in selection to choose the most suitable valve for each patient.