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Postoperative chylothorax development is associated with increased incidence and risk profile for central venous

M A McCulloch1, M R Conaway, J A Haizlip

  • 1Department of Pediatrics, Division of Cardiology, University of Virginia, Charlottesville, VA 22908, USA. mam3fk@virginia.edu

Pediatric Cardiology
|November 22, 2007
PubMed

Insights

Pediatric patients developing chylothorax (CTX) after congenital heart disease (CHD) surgery face a higher risk of central venous thrombosis (CVT). Early screening and central venous catheter (CVC) removal may reduce CTX and CVT incidence.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Thrombosis Research

Background:

  • Chylothorax (CTX) is a complication following congenital heart disease (CHD) surgery.
  • Central venous thrombosis (CVT) is a potential risk in these patients.
  • The relationship between CTX and CVT requires further investigation.

Purpose of the Study:

  • To test the hypothesis that pediatric patients with CTX after CHD surgery have an elevated incidence and risk profile for CVT.
  • To compare the incidence of CVT in patients with and without CTX post-CHD surgery.

Main Methods:

  • A case-control study evaluating 30 pediatric patients who developed CTX after CHD surgery.
  • Patients with CTX were matched with controls (NON-CTX) based on surgery, anatomy, and age.
  • Conditional logistic regression analyses were used to compare risk and incidence of CVT.

Main Results:

  • CTX development was linked to significantly longer ventilator dependence (14.8 vs. 6.1 days) and higher central venous pressures.
  • The incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group.
  • Postoperative extracorporeal membrane oxygenation (ECMO) increased CTX risk (OR 9.9).

Conclusions:

  • CTX development after CHD surgery is associated with a significantly elevated risk of CVT.
  • CTX is linked to increased mortality risk (OR 6.2).
  • Prospective CVT screening and early CVC removal may reduce CTX and CVT incidence.

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