36. Selective Use of Chest Tubes in Thoracotomies for Congenital Cardiovascular Procedures

Giorgio M. Aru, Andrew P. Dabbs, Erin R. Cummins, William L. Reno, Newt P. Harrison, William P. English, Bobby J. Heath

Dept. Of Surgery, University of MS. Medical Center

Jackson, Miss.

Advantages and complications have been reported from the use of chest tubes (CT). To reduce the incidence of complications we have employed a selective use of CT in thoracotomies for congenital cardiovascular procedures; i.e. in absence of air leaks and fluid to be drained no CT was inserted. The lung was re-expanded and air evacuated during the chest closure. Early and six hours chest x-rays were performed on every patient. This study retrospectively reviews the results of this selective approach in 546 patients operated on between 1980 and 1998 mainly for FDA ligation, PA band, aortic coarctation and BT shunt or a combination of the above. Four hundred eighteen patients did not receive a CT at the initial surgery (group one), and 128 patients received a CT either before or at surgery (group two). Forty patients in group one developed an air on fluid collection large enough to require a CT. Only one patient had complication, from an undetected hemothorax. Nine patients in group two required another CT and one patient developed a pneumothorax upon pulling out the CT. No death in either group was related to the use or lack of use of the CT. A total of 378 CTs and collecting chambers were saved. We conclude that a selective approach to the use of CT in Thoracotomies for cardiovascular procedures can be employed with minimal complications, more comfort for the patient and cost savings.