Selective use of chest tubes in thoracotomies for congenital cardiovascular procedures

Background. Advantages and complications have been reported from the use of chest tubes (CT). To reduce the incidence of complications we have employe d a selective use of CT in thoracotomy for congenital cardiovascular proced ure; ie, in absence of air leaks and fluid to be drained, no CT tvas insert ed. Methods. The lung was reexpanded and air evacuated during the chest closure . Early and 6 hours chest roentgenograms were performed on every patient. T his study retrospectively reviews the results of this selective approach in 546 patients operated on between 1980 and 1998 mainly for patent ductus ar teriosum ligation, pulmonary artery band, aortic coarctation, Blalock-Tauss ig shunt. Four hundred and eighteen patients did not receive a CT at the in itial surgery (group I), and 128 patients received a CT either before or at surgery (group II). Results. 40 patients in group I developed an air or fluid collection large enough to require a CT. Only one patient had complication, from an undetect ed hemothorax. Nine patients in group II required another CT, and one patie nt developed a pneumothorax upon pulling out the CT. No death in either gro up was related to the use or lack of use of the CT. A total of 378 CTs and collecting chambers were saved. Conclusions. A selective approach to the use of CT in thoracotomies for car diovascular procedures can be employed with minimal complications, more com fort for the patient, and cast savings. (C) 1999 by The Society of Thoracic Surgeons.