title: Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation.
abstract: Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43-15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34-6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23-0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08-0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.
authors.affiliation: From the *Department of Cardiac Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; †Department of Surgery, Duke University Medical Center, Durham, North Carolina; ‡Department of Cardiac Surgery, §Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; ¶Montreal Heart Institute, Montreal, Canada; ‖Department of Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota; and #Department of Thoracic Surgery, St. Charles Medical Center, Bend, Oregon.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.forename: Louis
authors.initials: L
authors.lastname: Perrault
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Edward M
authors.initials: EM
authors.lastname: Boyle
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056346:Sternotomy; D013908:Thoracotomy