A PATIENT PROFILING TOOL TO OPTIMIZE SURGICAL VALVE SELECTION FOR VALVE REPLACEMENT IN EGYPT
Author(s)
Mohamed El fiky, PhD1, Ahmed Ahmed, PhD1, Emad Sarawy, PhD2, Mohamed Elghanam, PhD1, Mohamed Sanad, PhD3, Tamer Mansour, PhD4, Baher Elezbawy, PhD5, Ahmad Fasseeh, PhD6, Ahmed Rasmy, PhD6, Sherif Attia Abaza, MBA7, Adham Salem, MSc8, Elhusseiny Gamil, PhD9.
1Department of Cardiothoracic surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt, 2National Heart Institute, Giza, Egypt, 3Mansoura University Hospitals, Mansoura, Egypt, 4Military Medical Academy, Cairo, Egypt, 5Health Economist, Syreon Middle East, Alexandria, Egypt, 6Syreon Middle East, Alexandria, Egypt, 7Syreon Middle East, Cairo, Egypt, 8Edwards Lifesciences, Dubai, United Arab Emirates, 9Department of Cardiothoracic surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
1Department of Cardiothoracic surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt, 2National Heart Institute, Giza, Egypt, 3Mansoura University Hospitals, Mansoura, Egypt, 4Military Medical Academy, Cairo, Egypt, 5Health Economist, Syreon Middle East, Alexandria, Egypt, 6Syreon Middle East, Alexandria, Egypt, 7Syreon Middle East, Cairo, Egypt, 8Edwards Lifesciences, Dubai, United Arab Emirates, 9Department of Cardiothoracic surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
OBJECTIVES: Different prosthetic valve types in surgical aortic valve replacement (SAVR) and surgical mitral valve replacement (SMVR) vary in key characteristics, including durability, requirement for long-term anticoagulation therapy, as well as acquisition cost. At the same time, patient-specific factors such as age, comorbidities, bleeding risk, lifestyle considerations, and ability to adhere to anticoagulation monitoring influence treatment suitability. Consequently, the optimal prosthetic valve differs across patient profiles. This study aimed to develop a structured patient profiling and decision-support tool to assist clinicians in selecting the most appropriate prosthetic valve for individual patients.
METHODS: A multi-step study was conducted. First, a literature review identified international and local guideline recommendations and decision criteria for prosthetic valve selection. Second, findings from a national survey of cardiothoracic surgeons in Egypt (n=128) were incorporated to reflect local clinical practice. Third, a consensus workshop with five cardiothoracic surgeons reviewed and refined a draft flowchart through scenario-based discussions. Final outputs included a decision flowchart and a standardized patient profiling form to support reimbursement decision-making.
RESULTS: The literature review identified consistent domains influencing prosthetic valve selection. Survey findings emphasized the importance of anticoagulation tolerance, adherence, and access to INR monitoring in prosthesis selection. Expert consensus produced a structured decision framework prioritizing anticoagulation eligibility as an initial step. Patients ineligible for anticoagulation are directed to bioprosthetic valves, with age thresholds (<65 aortic; <70 mitral) determining eligibility for novel versus standard bioprosthetic valves. Among patients eligible for anticoagulation, those with an existing mechanical valve are recommended to receive a mechanical valve, while the remaining patients are stratified by age, with younger patients receiving mechanical valves and older patients directed to standard bioprosthetic valves.
CONCLUSIONS: This patient profiling tool integrates clinical evidence and expert consensus to guide personalized prosthetic valve selection while supporting transparent reimbursement decisions and efficient allocation of healthcare resources.
METHODS: A multi-step study was conducted. First, a literature review identified international and local guideline recommendations and decision criteria for prosthetic valve selection. Second, findings from a national survey of cardiothoracic surgeons in Egypt (n=128) were incorporated to reflect local clinical practice. Third, a consensus workshop with five cardiothoracic surgeons reviewed and refined a draft flowchart through scenario-based discussions. Final outputs included a decision flowchart and a standardized patient profiling form to support reimbursement decision-making.
RESULTS: The literature review identified consistent domains influencing prosthetic valve selection. Survey findings emphasized the importance of anticoagulation tolerance, adherence, and access to INR monitoring in prosthesis selection. Expert consensus produced a structured decision framework prioritizing anticoagulation eligibility as an initial step. Patients ineligible for anticoagulation are directed to bioprosthetic valves, with age thresholds (<65 aortic; <70 mitral) determining eligibility for novel versus standard bioprosthetic valves. Among patients eligible for anticoagulation, those with an existing mechanical valve are recommended to receive a mechanical valve, while the remaining patients are stratified by age, with younger patients receiving mechanical valves and older patients directed to standard bioprosthetic valves.
CONCLUSIONS: This patient profiling tool integrates clinical evidence and expert consensus to guide personalized prosthetic valve selection while supporting transparent reimbursement decisions and efficient allocation of healthcare resources.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR1
Topic
Health Policy & Regulatory
Topic Subcategory
Coverage with Evidence Development & Adaptive Pathways, Reimbursement & Access Policy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Surgery