Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation. Issue 6 (November 2016)

• Record Type: Journal Article
• Authors: Maltais, Simon; Davis, Mary E.; Haglund, Nicholas A.; Perrault, Louis; Kushwaha, Sudhir S.; Stulak, John M.; Boyle, Edward M.
• Is Part Of: ASAIO journal. Volume 62:Issue 6(2016)
• Publication Date: 2016-11
• Subjects: ventricular assist device -- re-exploration -- bleeding -- chest tube; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000000437
• Languages: English
• ISSNs: 1058-2916

Abstract

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.