A supplement about drainology is a compliment to cardiothoracic surgery

Successful drainage strategies following surgery might be as old as the procedures themselves. The fact that this entity has found its way into academic debate mirrors the high level of surgical procedures and perioperative care that is provided nowadays.

In the gold rush era of cardiothoracic surgery, big steps towards a new era of surgery and disease treatment were to be made, and one was up to find ways to surgically approach the heart. In the 1950s, brilliant ideas on how to bypass heart and lung were pursued by pioneers like C. Walton Lillehei [1] and John H. Gibbon [2] allowing cardiac surgery to evolve from the cradle and surgeons to perform 1st cardiac operations. Chest drains accompanied these procedures, of course, but when procedural mortality was 50% and more, one was far from focusing on such supposedly irrelevant issues.

Since then, tremendous achievements were made, and today’s cardiothoracic surgery is highly standardized and provides a huge armamentarium of specific procedures often carrying a perioperative mortality of <1%. One has reached such a level of excellence that in several fields, surgical options are almost exploited and from a pure surgical standpoint, further improvements are unlikely. This might have extended the general focus now taking even less prominent details into account, such as perioperative chest drainage, its variations, potential developments and their impact on patient prognosis.

Twenty years ago, ‘retained blood syndrome’ [3] was a term probably not universally familiar nor were its various mechanical, inflammatory or arrhythmogenic implications. Nonetheless, thanks to academic surgeons not getting tired to look for uncharted niches, this perioperative issue was precisely elaborated [3] followed by discussions about proper drainage strategies and systems. Moreover, an analysis addressing the impact of a simple surgical manoeuvre for prevention of retained blood in the pericardium, namely posterior pericardiotomy, has found its way into one of the highest ranked medical journals [4]. The authors impressively reported the positive impact of this approach on lowering the postoperative incidence of atrial fibrillation. Consequently, a randomized trial has been set up and unrolled [5].

In the era of Lillehei and Gibbon, nobody might have suggested chest tube positioning and duration affecting patient mortality and morbidity, and it is impressive how deep one has gotten in analysing and re-evaluating all steps and details of perioperative care in cardiothoracic surgery. Thus, this supplement specifically focusing on ‘Drainology’ in the European Journal of Cardio-Thoracic Surgery is a real achievement and an affirmation as well. First, it should remind cardiothoracic surgeons on the tremendous scientific and clinical goals over the last decades that paved the way for such new fields of interest. Second, it underlines the importance of ongoing interest and curiosity that further improves the quality of cardiothoracic surgery. Last but not least, it provides interesting insights into recent findings one might transfer into daily practice.

FUNDING

This paper was published as part of a supplement financially supported by Medela.

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