Chylothorax following pediatric cardiac surgery

Abstract

Background: This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.