Introduction:The development of modern cardiac surgery after invention of cardiopulmonary bypass, new surgical techniques and advanced equipment has reduced the mortality rates and improved the outcome. There are more than 4000 cardiac surgery centers worldwide, but with unfair distribution: North America has one center per 120,000 population, while sub-Saharan Africa and Southeast Asia have just one center per 33 million and 16 million population, respectively. Thus, there is a real need to establish cardiac surgery centers in regions of need, especially in low- and middle-income countries.Starting cardiac surgery in a new university hospital with professional surgeons, well equipped operating rooms and unexperienced paramedical team is a true challenge.. Objectives:The objective is to evaluate the outcome of cardiac surgery in Kafrelsheikh university hospital from the beginning in 2018 till the end of the study. Materials and methods:A total of 428 consecutive patients underwent heart surgery at Kafrelsheikh University Hospital from 2018 through October 2023, were included in this retrospective and prospective data analysis. An overarching trend in cardiac surgery throughout time was more important than providing particular insights into groupings of procedures. Results:Between 2018 until its conclusion, this prospective and retrospective research tracked patients who had heart surgery at Kafrelsheikh University Hospital. In all, 428 operations were carried out during the research period, with 2023 seeing the highest annual case count of 103. From 2018 (n=41) to 2023 (n=103), the percentage of elective heart surgery operations has been continually rising. There was no notable disparity in age across the categories, with theexception of 2018 (P value<0.001). Among all six groups, there was no statistically significant difference in sex or BSA.The numbers of people who had heart procedures in the past were much greater in the 2023 and 2022 groups compared to the 2020, 2019, and 2018 groups (P = 0.025). Aortic cross-clamp time and cardiopulmonary bypass time were significantly lower in (group 2023, 2022 and 2021) than (group 2020,2019 and 2018) (P value<0.05). In comparison to groups 2020, 2019, and 2018, the durations of mechanical ventilation, intensive care unit stays, and hospital stays ingroups 2023, 2022, and 2021 were considerably shorter (P value<0.001). Our study reveals that mortality and morbidity are the same without significant difference ( p value : 0.987 ). Conclusion: Considering our center's relative youth and the high prevalence of comorbidities among our patients, we maintain that our death and morbidity rates are within acceptable ranges. We have also seen improvements in a number of other quality indicators. Such results in our early experienced center reflects the marvelous progress of our surgeons and that led to doing complicated surgical procedures as bentall, off pump surgery, valve repair and other difficult cases with comorbidities. It also shows how the surgical intensive care unit and paramedical team have improved their abilities, which has led to better infection control and healthier patients. Our facility may be brand new, but the high-quality tools we use allow our surgical teams to greatly enhance their patients' well-being and the success of their procedures. Important to the result was the collaboration between different sections of our facility.