Pleural drainage following total cavopulmonary connection in the era of central venous catheter

Background Pleural effusion after the Fontan operation contributes significantly to morbidity and prolonged hospitalization. The purpose of the present study was to investigate whether chest tubes placed in different cavities during the surgery would contribute to the drainage and also to evaluate risk factors of thoracic drainage with central venous catheter after total cavopulmonary connection in the era of the central venous catheter. Methods From January 2009 to June 2012, 109 consecutive patients underwent total cavopulmonary connection at Guangdong General Hospital. With 102 patients for investigation, preoperative, intraoperative and postoperative factors were obtained. Thoracic drainage with central venous catheter was whenever necessary. Duration of chest tube drainage and time of thoracic drainage with central venous catheter added up to total duration of pleural drainage. Binary logistic regression using forward LR method was applied for the analysis of the risk factors for thoracic drainage with central venous catheter. Results After total cavopulmonary connection, compared with chest tubes placed in single pleural cavity with or without pericardial or retrosternal cavity, those in both pleural cavities seemed to have the chance of longer hospital stay （P = 0.028）. No other significant differences were obtained in factors of ventilation time, extubated central venous pressure in superior vena cava, ICU stay, total duration of pleural drainage. Sildenafil was the preventive factor for reducing central venous pressure and preventing from postoperative pleural effusion. Conclusions After total cavopulmonary connection, patients with tubes placed in both pleural cavities would not have the chance of shorter total duration of pleural drainage and surprisingly turns out to have longer hospital stay. Sildenafil is a preventive factor for thoracic drainage with central venous catheter.