Management and overview of postoperative chylothorax after congenital cardiothoracic surgery

Abstract

Background: The aim of the study was to determine the incidence, risk factors, and outcomes for chylothorax in patients undergoing cardiothoracic surgery, with special emphasis on its management.Methods: Total of 24 patients with post-operative chylothorax, operated from September 2015 to December 2018, was included in the study. Medical records were maintained, including daily records of drainage volumes and management.Results: From September 2015 to December 2018, there were 24 cases of chylothorax in 600 congenital cardio-thoracic surgeries-an incidence of 4.0%. Overall mortality rate was similar, but cases had longer postoperative hospital stays (median, 22 versus 8 days). Incidence of chylothorax was significantly higher with congenital cardiac procedures. Diagnosis was made at a median of 6 days after surgery. Duration of drainage was a median of 15 days, with 11 patients draining more than 30 days. Longer duration of drainage was associated with cavopulmonary anastomosis procedure. Nutritional management included low fat diet, enteral feeds enriched with medium-chain triglycerides, and parenteral nutrition. Three patients were treated with octreotide, 4 with thoracic duct ligation, and 1 with pleurodesis. Octreotide was associated with a variable effect on drainage. Thoracic duct ligation reduced, but did not stop drainage.Conclusions: Chylothorax increases duration of hospitalization after cardiovascular surgery in children. Early diagnosis may reduce the duration of chylothorax. Nutritional strategies remain the cornerstone for management of postoperative chylothorax. The impact of octreotide and surgical intervention is limited when reserved for patients with severe or prolonged drainage.