Lever C G, Ross D B, Page L K, La Prairie A, Molyneaux M, Murphy D A
Department of Surgery, Victoria General Hospital, Halifax, NS.
Can J Surg. 1995 Dec;38(6):492-6.
To compare the performance and cost-effectiveness of cryopreserved homograft cardiac valves prepared on site to valves prepared commercially.
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).
Tertiary-care adult and pediatric hospitals.
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.
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.
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.
On-site preparation is an effective method of preparing cryopreserved cardiac valves and permits significant cost savings.
比较现场制备的冷冻保存同种异体心脏瓣膜与商业制备瓣膜的性能及成本效益。
回顾1990年1月至1993年12月期间所有接受同种异体心脏瓣膜移植的患者，并进行成本效益分析。随访时间为1至37个月（平均12个月）。
三级医疗成人及儿科医院。
自1990年开始现场制备冷冻保存心脏瓣膜以来，所有连续接受主动脉或右心室流出道（RVOT）位置同种异体心脏瓣膜移植的患者。43例患者接受了47次同种异体瓣膜置换：18例在主动脉位置，29例在RVOT位置。无患者失访。
通过患者生存率、再次手术的精算自由度以及经瓣压差和瓣膜反流的多普勒超声心动图评估来评估瓣膜功能。通过对现场成本与商业制备瓣膜当前价格的正式评估来评估成本效益。
有4例手术死亡，但无晚期死亡。4个瓣膜被移除。主动脉瓣置换术后3年再次手术自由度为100%，RVOT重建为85%。对其余39例患者中的34例进行超声心动图随访，结果显示24个瓣膜有轻度反流或无反流，8个瓣膜有中度反流，2个瓣膜有重度反流但无临床意义。现场制备瓣膜的成本为1363美元，而商业制备瓣膜的成本为5040美元，该组节省成本172,819美元。
现场制备是制备冷冻保存心脏瓣膜的有效方法，可显著节省成本。
