title: Blake drains: a novel method of chest drainage after extracardiac fontan operation with autologous pericardium.
abstract: BACKGROUND
  Pleural effusions after Fontan palliation remain a cause of increased length of stay, cost, and morbidity. We report our experience with Blake drains (BDs) and the outpatient pediatric pleural drain pathway after Fontan operation.
  
  
  METHODS
  A retrospective chart review was performed on all patients who underwent extracardiac lateral tunnel (ECLT) Fontan operation with pedicled autologous pericardium. Patients with prolonged pleural drainage were analyzed for predisposing factors.
  
  
  RESULTS
  From March 1995 to December 2009, 162 patients (92 male, 56.8%) underwent ECLT Fontan operation. The median age at the time of Fontan operation was 30.9 months; the median weight was 12.9 kg. The median hospital stay was 4 days, and the median pleural drain requirement was 13 days. Prolonged pleural effusions occurred in 59 patients (36.4%), with prolonged cardiopulmonary bypass time identified as the only significant risk factor (p=0.04). Sixty patients (37%) were readmitted within 30 days of operation, with effusion requiring additional pleural drainage (n=41, 68.3%), infection (n=8, 13.3%), or a combination of the two (n=3, 5%) being the most common reason. There were two early deaths, neither of which was associated with BD malfunction. The BD clinical pathway for ECLT Fontan operation reduced our institutional cost to about $38,000 per patient, which represents a significant savings compared with traditional management with extended hospital stay after Fontan operation.
  
  
  CONCLUSIONS
  Silicone BDs are safe and effective after ECLT Fontan operation. Hospital length of stay and cost can be significantly decreased when these drains are used with appropriate family involvement and close outpatient surveillance.
authors.affiliation: Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Department of Cardiovascular and Thoracic Surgery, Loma Linda University, Loma Linda, California 92354, USA. brgordon@llu.edu
authors.forename: Brent M
authors.initials: BM
authors.lastname: Gordon
authors.forename: Nahidh W
authors.initials: NW
authors.lastname: Hasaniya
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Newcombe
authors.forename: Noha S
authors.initials: NS
authors.lastname: Daher
authors.forename: Upinder
authors.initials: U
authors.lastname: Jodhka
authors.forename: Anees J
authors.initials: AJ
authors.lastname: Razzouk
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Bailey
mesh_terms: D002140:California / Q000453:epidemiology; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015505:Chest Tubes; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D010996:Pleural Effusion / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome