Background :Vulvular heart replacement surgery is an increasingly important in cardiac valve disease management .VHRS tends to be suitable for clinical pathway development because high volume , high cost of the surgery and predictable course of events that occur during hospitalization .The aim of this study was to determine the effects of implementing clinical pathway on pain and anxiety for patients undergoing cardiac surgery . Subject and methods, this is a randomized controlled design was utilized . This study was carried out in cardiothoracic surgery unit at the Mansoura University Hospital . A Purposeful sample of
50 adult patients of both sexes scheduled for vulvular heart replacement surgery was included in the study (25 clinical path group and 25 control group ). Two tools used for data collection pain scale tool and State trait anxiety inventory .The clinical pathway for cardiac surgery patients conducted in four phases : Phase one : patients assessment , Phase two
:cardiac valve surgery clinical pathway establishment and jury . Phase three: implementation and tracking variances . Phase four :Evaluation .The main results of study demonstrated no statistical significant differences in basic data on admission ,.the CP group had significantly lower level of anxiety and pain than the control group before and after surgery . All of the patients in CP group had no variance from VHRS pathway which prove the preset hypothesis of the study .