Factors influencing early and late outcome following Fontan procedure in the current era.

fibrinogen and thrombin to reduce air leak, duration of drainage and hospital stay. We welcome their conclusion on the safety and efficacy of biosynthetic sealants to minimise air leaks, a finding which contrasts the conclusions of a recent Cochrane review based on the results of trials that were selected for inclusion [2]. Unfortunately, we cannot agree with their statement that theirs was the only trial of sealants to demonstrate benefits in both time to drain removal and hospital discharge. Our study at the Brompton Hospital published in February 2006 demonstrated significant reduction in the duration of air leak (1 vs 4 days; P < 0.001), duration of chest drain (4 vs 5 days; P = 0.012) and hospital stay (6 vs 7 days; P = 0.004) [3]. Nevertheless, we would agree that further investigation is appropriate. However, with the demonstrated efficacy of surgical sealants, the question should not focus on efficacy compared to control, but rather relative efficacy between different forms of sealants.