A method for mediastinal drainage after cardiac procedures using small silastic drains

Background. It has been standard teaching in cardiac surgery that drainage of the mediastinum following cardiac surgical procedures is best accomplish ed using rigid large-bore chest tubes. Recent trends in cardiac surgery hav e suggested less invasive approaches to a variety of diseases. Difficult dr ainage problems in the field of general surgery including hepatic and pancr eatic collections have been drained successfully with smaller flexible drai ns for many years. Additionally, many difficult to reach collections in the chest have been drained by invasive radiologists using small pigtail cathe ters. Methods. We have introduced drainage of the mediastinum using 10-mm flexibl e, flat, fluted Blake drains. To date, we have used these drains in more th an 100 cardiac operations including coronary artery bypass grafting, valve repair/replacements, combined coronary artery bypass grafting/valve operati ons, heart transplants, septal defects, and mediastinal tumors. Results. We have demonstrated that this form of drainage is as good as usin g large-bore chest tubes with no significant risk of bleeding or tamponade. Additionally, use of these tubes is less painful, allows more mobility, an d earlier discharge with functioning drains in place if necessary. Conclusions. Larger chest tubes are not necessarily better when it comes to draining the mediastinum. The actual area of ingress through the sideholes is considerably less than the surface area provided by the fluted Blake dr ain. We believe that this system can replace standard chest tubes. (Ann Tho rac Surg 2000;70:1109-10) (C) 2000 by The Society of Thoracic Surgeons.