Chylothorax complicating repairs of the descending and thoracoabdominal aorta

Chylothorax occurring during thoracic aortic surgery is an infrequent but serious complication. The purpose of this study was to analyze our experience with this complication and the resulting outcomes.

From January 1991 to July 2005, we performed 1,233 descending thoracic and thoracoabdominal aortic surgical procedures. A retrospective review was performed to analyze and identify preoperative and operative risk factors as well as management outcomes of postoperative chylothorax (PCT).

PCT developed in five patients (0.4%). All five cases occurred with descending thoracic aortic aneurysm repair, and 80% (four of five patients) were undergoing aortic reoperation. All patients were managed successfully with no mortality. Risk factors for the development of chylothorax were descending thoracic aortic repair (p = 0.006) and thoracic aortic reoperations (p = 0.0003). Nonoperative management was successful in 60% (three of five patients). Two patients required left thoracotomy with direct ligation. Mean hospital length of stay was 35 days (range, 15 to 60 days). Mean follow-up was 33 months (range, 3 to 69 months) with no recurrence of chylothorax or additional morbidity or mortality.

Chylothorax is more likely to occur with reoperations and repairs involving the descending thoracic aorta. Although PCT is associated with longer hospital length of stay, it is not associated with increased infectious complications. Early identification and prompt treatment may decrease both early and late morbidity and mortality.