Skip to main content Accessibility help
×
Home
Hostname: page-component-768dbb666b-t89mg Total loading time: 0.289 Render date: 2023-02-05T23:28:05.384Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Chylothorax following paediatric cardiac surgery: a case–control study

Published online by Cambridge University Press:  24 August 2017

Thomas G. Day*
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
Diana Zannino
Affiliation:
Heart Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
Daniel Golshevsky
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
Yves d’Udekem
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia
Christian Brizard
Affiliation:
Department of Cardiac Surgery, Royal Children’s Hospital, Parkville, Victoria, Australia
Michael M. H. Cheung
Affiliation:
Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia Heart Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
*
Correspondence to: T. G. Day, Department of Cardiology, Royal Children’s Hospital, Parkville, VIC, Australia. Tel: 02074059200; Fax: 02078298673; E-mail: tomgeorgeday@gmail.com

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.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

1. Zuluaga, MT. Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr 2012; 24: 291294.CrossRefGoogle ScholarPubMed
2. Haines, C, Walsh, B, Fletcher, M, et al. Chylothorax development in infants and children in the UK. Arch Dis Child 2014; 99: 724730.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
4. Chan, EH, Russell, JL, Williams, WG, et al. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 18641870.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
7. Chan, S, Lau, W, Wong, WHS, et al. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82: 16501656.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
10. Soto-Martinez, M, Massie, J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev 2009; 10: 199207.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
14. Milonakis, M, Chatzis, AC, Giannopoulos, NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369373.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
8
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Chylothorax following paediatric cardiac surgery: a case–control study
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Chylothorax following paediatric cardiac surgery: a case–control study
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Chylothorax following paediatric cardiac surgery: a case–control study
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *