Predictors of prolonged drainage of chylothorax after cardiac surgery: single centre study

INTRODUCTION AND AIM OF THE WORK: Chylothorax is a clinical challenge. This study aims at determination of the predictors of prolonged drainage of chylothorax after cardiac surgery in a single tertiary centre in Jeddah, Saudi Arabia.

A retrospective analysis of 52 patients of chylothorax with a mean age of 30 months (range 1 month to 60 years) who developed chylothorax after heart surgery (January 2007-September 2010). Data were collected regarding patients demographics, procedures, chylous drainage and its management, complications and follow-up.

There was one hospital mortality. All patients were managed by fat-free diet or Monogen. Lone fat-free diet with steroids were used a in eight patients (15.4%). Somatostatin analogue (Octreotide) was used adjunctively in 7 (13.5%) patients and in two patients (3.8%), steroids and octreotide were used adjunctively. The median duration of chest tube drainage was 10.5 days (range 4-34 days). The median amount of chest tube drainage/kg/day was 18 mL (range 6.6-72 mL). All patients responded to medical treatment except one case who required thoracic duct ligation and a patient who died. The use of octreotide and steroids therapy significantly reduced the amount chest tube drainage. At median follow-up of 12 months (range 1-40 months) after hospital discharge, no recurrence of chylothorax was observed.

Chylothorax is much more common post-pediatric cardiac than post-adult cardiac surgery. Conservative therapy of chylothorax after cardiac surgery remains the standard approach. Steroids and or octreotide can be used with an acceptable success. The most significant predictor of prolonged chest tube drainage in chylothorax is triglyceride/cholesterol ratio more than 2.