Cost-effectiveness and efficacy of an on-site homograft heart-valve bank.
OBJECTIVE
To compare the performance and cost-effectiveness of cryopreserved homograft cardiac valves prepared on site to valves prepared commercially.


METHODS
A review of all patients who received homograft heart valves between January 1990 and December 1993, with cost-effectiveness analysis. Follow-up ranged from 1 to 37 months (mean 12 months).


METHODS
Tertiary-care adult and pediatric hospitals.


METHODS
All consecutive patients receiving homograft heart valves in either the aortic or right ventricular outflow tract (RVOT) position since on-site preparation of cryopreserved cardiac valves began in 1990. Forty-three patients received 47 homograft valve replacements: 18 in the aortic position and 29 in the RVOT position. No patients were lost to follow-up.


METHODS
Valve function as assessed by patient survival, actuarial freedom from reoperation and Doppler echocardiographic assessment of transvalvar gradients and valvar insufficiency. Cost-effectiveness as assessed by a formal evaluation of on-site costs compared with current prices for commercially prepared valves.


RESULTS
There were four operative deaths but no late deaths. Four valves were removed. Freedom from reoperation at 3 years was 100% for aortic valve replacement 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 clinically significant, insufficiency in 2 valves. The cost of on-site preparation 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 cryopreserved cardiac valves and permits significant cost savings.
D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D015925:Cryopreservation / Q000191:economics; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D006351:Heart Valves / Q000637:transplantation*; D006801:Humans; D009674:Nova Scotia; D011183:Postoperative Complications; D012086:Reoperation; D014015:Tissue Banks / Q000191:economics*; D014184:Transplantation, Homologous