Skip to main content Accessibility help
×
Home

Chylothorax following paediatric cardiac surgery: a case–control study

  • Thomas G. Day (a1), Diana Zannino (a2), Daniel Golshevsky (a1), Yves d’Udekem (a3), Christian Brizard (a3) and Michael M. H. Cheung (a1) (a2) (a4)...

Abstract

Objectives

The aims of this study were to investigate risk factors for the development of postoperative chylothorax following paediatric congenital heart surgery and to investigate the impact of a management guideline on management strategies and patient outcome.

Methods

All patients with chylothorax following cardiac surgery at the Royal Children’s Hospital, Melbourne, over a 48-month period beginning in January 2008 were identified. A control group, matched for age, date of surgery, and sex, was identified. To investigate potential risk factors, univariable and multivariable logistic regression models were constructed with paired analysis. To examine the effect of a standardised management protocol, data before and after the implementation of the guideline were compared.

Results

In total, 121 cases of chylothorax were identified, with 121 controls, matched for age at surgery, date of surgery, and sex. The incidence of chylothorax was 5.23%. Increasing surgical complexity (univariable OR 0.17 for the least complex versus the most complex group, p=0.02), closed-heart surgeries (OR 0.07 for open versus closed, p<0.001), and redo chest incisions (OR 10.0 for redo versus virgin, p<0.001) were significantly associated with chylothorax. The standardised management protocol had no significant impact on either drainage duration or management strategy.

Conclusions

We have replicated the previously reported association between surgical complexity and chylothorax risk, and have shown, for the first time, that redo chest openings are also associated with a significantly increased risk. The implementation of a standardised management protocol in our institution did not result in a significant change in either chylothorax drainage duration or management strategy.

Copyright

Corresponding author

Correspondence to: T. G. Day, Department of Cardiology, Royal Children’s Hospital, Parkville, VIC, Australia. Tel: 02074059200; Fax: 02078298673; E-mail: tomgeorgeday@gmail.com

Footnotes

Hide All

Current address: Cardiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, United Kingdom.

Footnotes

References

Hide All
1. Zuluaga, MT. Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr 2012; 24: 291294.
2. Haines, C, Walsh, B, Fletcher, M, et al. Chylothorax development in infants and children in the UK. Arch Dis Child 2014; 99: 724730.
3. Mery, CM, Moffett, BS, Khan, MS, et al. Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 2014; 147: 67886.e1; discussion 685–686.
4. Chan, EH, Russell, JL, Williams, WG, et al. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 18641870.
5. Borasino, S, Diaz, F, El Masri, K, et al. Central venous lines are a risk factor for chylothorax in infants after cardiac surgery. World J Pediatr Congenit Heart Surg 2014; 5: 522526.
6. Biewer, ES, Zürn, C, Arnold, R, et al. Chylothorax after surgery on congenital heart disease in newborns and infants – risk factors and efficacy of MCT-diet. J Cardiothorac Surg 2010; 5: 127.
7. Chan, S, Lau, W, Wong, WHS, et al. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82: 16501656.
8. White, SC, Seckeler, MD, McCulloch, MA, et al. Patients with single ventricle anatomy may respond better to octreotide therapy for chylothorax after congenital heart surgery. J Card Surg 2014; 29: 259264.
9. Doell, C, Bernet, V, Molinari, L, et al. Children with genetic disorders undergoing open-heart surgery: are they at increased risk for postoperative complications? Pediatr Crit Care Med 2011; 12: 539544.
10. Soto-Martinez, M, Massie, J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev 2009; 10: 199207.
11. Yeh, J, Brown, ER, Kellogg, KA, et al. Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. Ann Thorac Surg 2013; 96: 930936.
12. Caverly, L, Rausch, CM, Da Cruz, E, et al. Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis 2010; 5: 573578.
13. Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.
14. Milonakis, M, Chatzis, AC, Giannopoulos, NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369373.
15. Nguyen, DM, Shum-tim, D, Dobell, ARC, et al. The management of chylothorax/chylopericardium following pediatric cardiac surgery: a 10-year experience. J Card Surg 1995; 10 (Pt 1): 302308.
16. Chen, C-A, Wang, J-K, Lue, H-C, et al. A shift from underweight to overweight and obesity in Asian children and adolescents with congenital heart disease. Paediatr Perinat Epidemiol 2012; 26: 336343.

Keywords

Chylothorax following paediatric cardiac surgery: a case–control study

  • Thomas G. Day (a1), Diana Zannino (a2), Daniel Golshevsky (a1), Yves d’Udekem (a3), Christian Brizard (a3) and Michael M. H. Cheung (a1) (a2) (a4)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed