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Chylothorax following paediatric cardiac surgery: a case–control study

Published online by Cambridge University Press:  24 August 2017

Thomas G. Day Open the ORCID record for Thomas G. Day [Opens in a new window] ,
Diana Zannino ,
Daniel Golshevsky ,
Yves d’Udekem ,
Christian Brizard  and
Michael M. H. Cheung
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
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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.

Keywords

Chylothoraxcardiac surgerypaediatrics
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 222 - 228
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Copyright
© Cambridge University Press 2017 

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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: 291–294.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: 724–730.Google Scholar
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: 678–86.e1; discussion 685–686.Google Scholar
4. Chan, EH, Russell, JL, Williams, WG, et al. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 1864–1870.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: 522–526.Google Scholar
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 ScholarPubMed
7. Chan, S, Lau, W, Wong, WHS, et al. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82: 1650–1656.Google Scholar
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: 259–264.Google Scholar
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: 539–544.Google Scholar
10. Soto-Martinez, M, Massie, J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev 2009; 10: 199–207.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: 930–936.Google Scholar
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: 573–578.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: 110–118.Google Scholar
14. Milonakis, M, Chatzis, AC, Giannopoulos, NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369–373.Google Scholar
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): 302–308.Google Scholar
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: 336–343.CrossRefGoogle ScholarPubMed