COST-EFFECTIVENESS AND EFFICACY OF AN ON-SITE HOMOGRAFT HEART-VALVE BANK

OBJECTIVE: To compare the performance and cost-effectiveness of cryopr eserved homograft cardiac valves prepared on site to valves prepared c ommercially. DESIGN: A review of all patients who received homograft h eart valves between January 1990 and December 1993, with cost-effectiv eness analysis. Follow-up ranged from 1 to 37 months (mean 12 months). SETTING: Tertiary-care adult and pediatric hospitals. PATIENTS: All c onsecutive patients receiving homograft heart valves in either the aor tic or right ventricular outflow tract (RVOT) position since on-site p reparation of cryopreserved cardiac valves began in 1990. Forty-three patients received 47 homograft valve replacements: 18 in the aortic po sition and 29 in the RVOT position. No patients were lost to follow-up . MAIN OUTCOME MEASURES: Valve function as assessed by patient surviva l, actuarial freedom from reoperation and Doppler echocardiographic as sessment of transvalvar gradients and valvar insufficiency. Cost-effec tiveness as assessed by a formal evaluation of on-site costs compared with current prices for commercially prepared valves. RESULTS: There w ere four operative deaths but no late deaths. Four valves were removed . Freedom from reoperation at 3 years was 100% for aortic valve replac ement and 85% for RVOT reconstruction. Echocardiographic follow-up of 34 of the remaining 39 patients showed mild or no insufficiency in 24 valves, moderate insufficiency in 8 valves and severe, but not clinica lly significant, insufficiency in 2 valves. The cost of on-site prepar ation of the valves was $1363 compared with $5040 for the commercially prepared valves, a cost saving for the group of $172 819. CONCLUSIONS : On-site preparation is an effective method of preparing cryopreserve d cardiac valves and permits significant-cost savings.