P2.B030: Early mediastinal chest tube removal following cardiac surgery is rarely associated with pericardial effusions requiring intervention

Background: There are no accepted guidelines for mediastinal chest tube removal following cardiopulmonary bypass surgery and management is highly variable. Some centers have elaborate chest tube removal algorithms. Our institutional routine is to remove the mediastinal chest tube on postoperative day (POD) one. The aim of this retrospective study was to review our experience with early mediastinal chest tube removal on POD 1.

Methods: Retrospective review of all patients undergoing cardiopulmonary bypass surgery from January 1, 2023-December 31, 2023 who had their mediastinal chest tubes removed on POD 1 (74%). Patients were excluded if they died prior to hospital discharge, had PleurX catheter placed with the intention of going home with the catheter, or had an anterior mediastinal chest tube and a posterior Blake drain in the pericardial space. Variables examined included: age, operation, chest tube output from midnight to removal in mL/kg/hr, postoperative complications, postoperative hospital length of stay, discharge echocardiogram, intervention(s) for effusion if present, and readmission within 30 days postoperatively.

Results: 74% (n=158) of our postoperative patients had their mediastinal chest tubes removed on POD1. Average patient age 6+8 years; median 1.6 years (range 2 days to 39 years). Operations included: atrial septal defect repair n=27, ventricular septal defect repair n=26, tetralogy of Fallot repair n=15, partial anomalous venous return repair n=8, atrioventricular septal defect repair n=7, relief of right ventricular outflow tract obstruction (including right ventricle-pulmonary artery conduit revision) n=15, left ventricular outflow tract operations (including aortic valve replacement and arch operations) n=24, mitral valve replacement/repair n=7, arterial switch operation (alone or in conjunction with ventricular septal defect closure) n=5, bidirectional Glenn shunt or comprehensive Stage II n= 11, repair of coronary artery anomalous origin n=5, and other procedures n=8. Average postoperative duration of mediastinal chest tube was 22.5+3 hours; median 22 hours (range 11-36 hours). Average mediastinal chest tube output from midnight to removal was 0.34+0.26 mL/kg/hr; median 0.29 mL/kg/hr (range 0-1.23 mL/kg/hr). There were four major postoperative complications: unplanned cardiac reoperation n=2, unplanned cardiac catheterization n=1, permanent pacemaker placement for heart block n=1. None related to removal of mediastinal chest tube. Fourteen patients (9%) had small pericardial effusions noted on discharge echocardiogram. Average postoperative hospital length of stay was 7+11days; median 4 days (range 2-78 days). Three of 158 patients (2%) were readmitted with pericardial effusions that required pericardial drain placement in the cath lab.

Conclusion: Early mediastinal chest tube removal following cardiopulmonary bypass surgery is rarely associated with pericardial effusion requiring intervention. Patients with small pericardial effusions noted on discharge echocardiograms may require more frequent follow up as outpatients.