Surgical management and risk factors of chylothorax following congenital heart surgery
A stepwise therapeutic strategy for managing postoperative chylothorax in pediatric patients shows an 82.8% resolution rate through conservative measures.
Where it sits
this study against the rest of the octreotide corpusSummary and findings
This study evaluated the clinical efficacy of a stepwise therapeutic strategy for postoperative chylothorax in 64 pediatric patients following congenital heart surgery. Treatment strategies included enteral nutrition, total parenteral nutrition, administration of octreotide, and invasive interventions. Resolution of chylothorax was achieved in 53 patients (82.8%) through conservative management alone.
Abstract
<title>Abstract</title> <p>Chylothorax is a well-recognized postoperative complication following pediatric surgery for congenital heart disease and is closely associated with adverse clinical outcomes. This study aimed to evaluate the clinical efficacy of a stepwise therapeutic strategy for postoperative chylothorax after congenital heart surgery, and to identify risk factors associated with refractory cases requiring invasive intervention as well as with mortality. A retrospective analysis was conducted on 64 patients diagnosed with postoperative chylothorax between 2007 and 2023. Treatment strategies included: 1. Enteral nutrition with medium-chain triglyceride or a low-fat diet, 2. Nil per oral with total parenteral nutrition, 3. Administration of octreotide, and 4. Invasive interventions such as thoracic duct ligation and lymphaticovenous anastomosis (LVA). Chylothorax was diagnosed based on a pleural fluid triglyceride level exceeding 1.1 mmol/L, or a leukocyte count greater than 1,000/µL with a predominance of mononuclear cells (≥ 80%). Resolution of chylothorax was achieved in 53 patients (82.8%) through conservative management alone, encompassing treatment from Step1-3. 11 patients (17.2%) required invasive intervention, with LVA adopted as the primary surgical approach from 2017 onward. Significant risk factors for requiring invasive treatment included younger age (p = 0.03), lower body weight (p = 0.02), and the presence of superior vena cava obstruction or stenosis (p < 0.001). Notably, all 3 patients who died had a history of catheter-based intervention for superior vena cava obstruction or stenosis. Overall, the prognosis was favorable; however, outcomes were markedly poorer in patients with stenosis or obstruction compromising venous return from the upper body.</p>