The total cavopulmonary connection (TCPC) operation is the last stage in the palliative treatment of patients with a univentricular heart malformation. Prolonged pleural and peritoneal effusions, however, remain as a significant source of morbidity after the TCPC operation. 1,2 The high pre-operative pulmonary artery pressure is a risk factor for prolonged pleural effusion. 3 Sildenafil has been used in the treatment of pulmonary hypertension. Sildenafil reduces pulmonary vascular resistance and the transpulmonary gradient, which could, in theory, decreases pleural and peritoneal effusions after the TCPC operation. 4 Therefore, in 2006, our institution started the administration of sildenafil after the TCPC operation for occasional patients and usually later than 24 hours after the operation, and since 2009, the majority of the patients received their first dose of sildenafil pre-operatively in the morning of the operation.However, the benefits of sildenafil have been controversial in the two recent retrospective Fontan series. 5,6 Our aim in this study was to analyze the effect of prophylactic sildenafil on pleural and peritoneal effusions during the first post-operative day (POD) after the TCPC surgery. We hypothesized that the

Children with open-heart surgery are a major patient group in paediatric intensive care. Optimizing postoperative processes for these patients is therefore essential. The duration of mechanical ventilation (MV) is a key determinant of postoperative length of stay (LOS) in paediatric intensive care units (PICUs). In adults, early extubation after cardiac surgery reduces length of stay (LOS) in the intensive care unit (ICU) and leads to lower costs without increased risks for the patient. 1,2 With the development of fast-track protocols, there

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