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Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery
Doğan Kahraman1, Gökhan Keskin2, Emced Khalil3
1Department of Cardiovascular Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey.
The Heart Surgery Forum
|March 3, 2020
Summary
Chylothorax after cardiac surgery, a serious complication, can be managed with medical treatment, pleurodesis, or duct ligation. Medical management, including steroids, is often the initial strategy for chylothorax.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pediatric Surgery
Background:
- Chylothorax and pseudo-chylothorax are significant complications following adult and pediatric cardiac surgery.
- This study details a 10-year clinical experience with these complications.
Purpose of the Study:
- To analyze the incidence, management, and outcomes of chylothorax post-cardiac surgery.
- To evaluate different treatment strategies, including medical, pleurodesis, and surgical interventions.
Main Methods:
- Retrospective analysis of 4896 cardiovascular surgeries from 2008-2019.
- Identified 47 patients with chylothorax/pseudo-chylothorax, with detailed analysis of effusion characteristics and treatment modalities.
- Treatments included somatostatin/octreotide, dexamethasone, chemical pleurodesis with fibrin glue, and surgical duct ligation.
Main Results:
- Chylothorax occurred in 4.8% of patients (22 adult, 20 pediatric).
- Medical treatment (somatostatin/octreotide, steroids) resolved chylothorax in 48.9% of patients within 24.2 days.
- Pleurodesis with fibrin glue and surgical duct ligation were successful in refractory cases, with no observed mortality or morbidity.
Conclusions:
- Chylothorax is a notable complication in pediatric cardiac surgery.
- Early medical treatment, including steroids, is recommended.
- Pleurodesis and surgical ligation are effective for persistent cases, with surgical ligation reserved as a last resort.
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