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Ann Thorac Surg 2005;80:1864-1870
© 2005 The Society of Thoracic Surgeons

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Original article: General thoracic

Postoperative Chylothorax After Cardiothoracic Surgery in Children

^a Department of Pediatrics, Division of Pediatric Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
^b Department of Surgery, Division of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada

Accepted for publication April 26, 2005.

^_* Address correspondence to Dr McCrindle, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada (Email: brian.mccrindle{at}sickkids.ca).

BACKGROUND: The purpose of this study is to determine the incidence, risk factors, and outcomes for chylothorax in children undergoing cardiothoracic surgery.

METHODS: Hospital databases were used to identify chylothorax cases. Surgical databases were used to identify all patients undergoing cardiothoracic surgery. Medical records were reviewed, including daily records of drainage volumes and management.

RESULTS: From September 2000 to December 2002, there were 48 cases of chylothorax in 1,257 surgeries—an incidence of 3.8% (95% confidence interval: 2.8% to 4.8%). Overall mortality rate was similar, but cases had longer postoperative hospital stays (median, 22 versus 8 days; p < 0.001). Incidence of chylothorax was significantly higher with heart transplantation and Fontan 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 procedures and longer time to diagnosis of chylothorax. Nutritional management included low fat diet, enteral feeds enriched with medium-chain triglycerides, and parenteral nutrition. Five 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.

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