Objective To investigate the association between preoperative

operative

and postoperative factors and persistent pleural effusion after the extracardiac Fontan procedure. Methods Ninety-five consecutive patients diagnosed with univentricular heart underwent extracardiac connection using Gore-Tax conduits at the Department of Children’s Heart Centre

Justus-Liebig-University Giessen in Germany from June 1996 to July 2007. The outcome measures were duration and volume of chest tube drainage after surgical intervention. The investigated factors included age and weight at the time of operation

anatomical diagnosis

preoperative oxygen saturation

mean pulmonary artery pressure

ventricular end-diastolic pressure

fenestration

cardiopulmonary bypass time

conduit size

postoperative pulmonary artery pressure

administration of angiotensin-converting enzyme inhibitors

and postoperative infection. Associations between these factors and persistent pleural effusion after the extracardiac Fontan procedure were analyzed. Results Every patient suffered postoperative effusion. The median duration of postoperative chest tube drainage was 9 days (range

3-69 days)

and the median volume was 12 mL·kg-1·d-1 (range

2.0-37.5 mL·kg-1·d-1). Thirty-seven (38.9%) patients had pleural drainage for more than 15 days

and the volume in 35 (36.8%) patients exceeded 25 mL·kg-1·d-1. Nineteen (20%) patients required placement of additional chest tubes for re-accumulation of pleural effusion after removal of previous chest tubes. Fifteen (17.8%) patients were hospitalized again due to pleural effusion after discharge. The median length of hospital stay after the operation was 14 days (range

4-78 days). Multivariate analysis results showed that non-fenestration

low preoperative oxygen saturation

and postoperative infections were independent risk factors for prolonged duration of pleural drainage (P<0.05). Long cardiopulmonary bypass time

non-fenestration

small conduit size

and low preoperative oxygen saturation were independent risk factors for excessive volume of pleural drainage (P<0.05).Conclusions For reduing postoperative duration and volume of pleural drainage following Fontan procedure

it seems to be important to improve the preoperative oxygen saturation

use large size of conduit

shorten cardiopulmonary bypass time

and make fenestration during the operation

as well as avoid postoperative infections.