Drainology Symposium at DGTHG 2025
Optimization of the Surgical Journey
February 15 2025 at DGTHG 2025, the German National Meeting of Cardiothoracic and Vascular Surgery in Hamburg.
Summary by: Dr. med. Tulio Caldonazo
Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Germany.
Summary
Modern cardiac surgery is evolving to meet patient expectations by prioritizing symptom relief, functional recovery, and psychological well-being. The importance of structured preoperative communication in reducing anxiety and improving post-surgical outcomes was emphasized. Similarly, ERAS protocols in MICS, promoting early mobilization, pain control, and multidisciplinary coordination for faster recovery were highlighted by experts. Moreover, chest drainage management remains a critical factor in optimizing postoperative care. It was underscored the need for structured, evidence-based protocols to ensure safe early drain removal and seamless patient transitions. Advances in digital drainage systems and real-time monitoring enhance patient safety and work efficiency. Collectively, these strategies aim to refine recovery pathways and elevate standards in modern cardiac surgery.
Modern Cardiac Surgery: Are We Meeting Our Patients’ Expectations?
Prof. Dr. med. Hassina Baraki (Universitätsmedizin Göttingen)
Prof. Hassina Baraki emphasized the critical role of patient expectations in modern cardiac surgery, highlighting the need for symptom relief, functional improvement, and psychological well-being. Anxiety about surgery is common, with nearly 20% of patients developing depression, and studies have identified numerous pre- and post-operative anxiety factors. Structured conversations with physicians can significantly reduce fears, as patient-surgeon communication plays a crucial role in setting realistic expectations and improving outcomes. Psychological preparation has been shown to lower inflammatory markers and enhance recovery, as demonstrated in the Marburg study and the ongoing Psy-Heart 2 multicenter trial. Multidisciplinary support, including psychological counseling, further improves patient satisfaction. Prof. Baraki advocated for integrating psychological preparation into surgical protocols, recommending the ERAS+ model and digital counseling to address gaps in care. While AI and robotics are emerging, human empathy remains irreplaceable, and future research will continue refining psychological strategies to optimize patient experiences.
Moreover, Prof. Kutschka highlighted a critical improvement in postoperative patient management. Initially, it took up to 45 minutes to restore suction on drains after surgery, increasing the risk of complications like tamponade. By maintaining continuous suction at the end of surgery—previously impossible with other systems—early rethoracotomies have become nearly nonexistent. This change has significantly enhanced patient outcomes and convinced the team of its effectiveness.
“Modern cardiac surgery must align with patient expectations, addressing both physical recovery and psychological well-being. Empathetic communication and structured preoperative counseling significantly reduce anxiety and improve outcomes”
Optimal Post-Operative Care After MICS
Prof. Dr. med. Stephan Jacobs (Deutsches Herzzentrum der Charité)
Prof. Stephan Jacobs emphasized the importance of a team-based approach in optimizing recovery after minimally invasive cardiac surgery (MICS), highlighting the natural alignment of ERAS principles with these procedures. His study focused on a “Day Zero” protocol for minimally invasive mitral valve surgery, enabling direct postoperative transfer to the general ward and early rehabilitation, leading to shorter hospital stays and faster recovery. Success relies on a multidisciplinary team coordinating preoperative education, standardized surgical techniques, optimal perfusion strategies, fluid management, and pain control. At Charité, patients typically undergo surgery in the morning, are extubated by noon, and begin mobilization shortly afterwards. Prof. Jacobs advocated for the widespread adoption of tailored ERAS protocols, demonstrating that early mobilization, controlled pain management, and proactive discharge planning significantly enhance patient satisfaction and clinical outcomes. As MICS techniques evolve, refining recovery protocols will be crucial in establishing them as the gold standard in cardiac surgery.
“Enhanced recovery protocols naturally align with minimally invasive cardiac surgery, ensuring faster recovery and reduced hospital stays. A multidisciplinary team approach, beginning with preoperative education, is key to optimizing outcomes.”
One Day, One Drain: Opportunities and Risks
Prof. Dr. med. Jurij Kalisnik (Klinikum Klagenfurt)
Prof. Jurij Kalisnik highlighted the ongoing debate over the optimal timing of chest drain removal in cardiac surgery, balancing early discharge with patient safety. While some studies support early removal, others emphasize potential risks, leading to varying institutional protocols. In Klagenfurt, a structured approach aims to optimize postoperative management through early extubation and safe drain removal based on strict criteria rather than fixed timelines. Centers like Nürnberg and Strasbourg have shown that digital drainage systems, active suction settings, and careful patient selection improve outcomes, reducing complications like tamponade and atrial fibrillation. The evolving strategy prioritizes real-time monitoring and individualized patient assessment over rigid schedules. Future advancements may integrate predictive algorithms to enhance safety. Ultimately, well-defined protocols and continuous optimization are key to ensuring that early drain removal is both safe and effective.
“The key to early chest drain removal is not just whether it can be done, but under what conditions it is safe. Real-time monitoring, strict removal criteria, and patient-specific strategies are essential for minimizing risks.”
From Surgery to Discharge: Why is Drainage a Relay Race?
Prof. Dr. med. Anno Diegeler (Rhön-Klinikum Bad Neustadt a. d. Saale)
Prof. Anno Diegeler discussed the evolution of patient management in cardiac surgery, emphasizing the “flow principle” implemented in Bad Neustadt, which streamlines postoperative care through a structured recovery process. This approach has enhanced surgical efficiency but now faces challenges due to increasing case complexity. A key factor in maintaining this flow is effective drainage management, as improper removal or placement can lead to complications like atrial fibrillation and tamponade. Prof. Diegeler advocates for digital drainage systems, such as Thopaz+, which provide consistent suction, real-time monitoring, and reduced clotting risks, ultimately improving patient safety and easing nursing workflows. These systems also offer economic benefits by lowering complications and hospital resource usage. Despite initial resistance, their adoption has proven effective, reinforcing the importance of optimizing drainage protocols to improve surgical outcomes and ensure a seamless transition from surgery to discharge.
“Effective drainage management is crucial in preventing complications, and portable, digital systems enhance both patient safety and work efficiency. Optimizing these processes minimizes complications, accelerates recovery, and improves overall surgical outcomes.”