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Risk Factors and Long-Term Prognosis for Chylothorax After Total Cavopulmonary Connection in Children: A
Liting Bai1, Zhengyi Feng1, Ju Zhao1
1Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Chylothorax after total cavopulmonary connection (TCPC) surgery occurs in 15.5% of children, leading to prolonged hospital stays and lower survival rates. A dominant right ventricle and high post-operative central venous pressure are key risk factors.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Chylothorax is a serious complication following total cavopulmonary connection (TCPC) in pediatric patients.
- Understanding its incidence, risk factors, and prognosis is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence and identify risk factors for chylothorax post-TCPC.
- To assess the short- and long-term survival rates in children who develop chylothorax after TCPC.
Main Methods:
- Retrospective review of 386 pediatric patients who underwent TCPC between 2008 and 2020.
- Comparison of patients with and without post-operative chylothorax.
- Univariate/multivariate analyses for risk factors and Kaplan-Meier for survival analysis.
Main Results:
- Chylothorax incidence was 15.5% (60/386 patients).
- Chylothorax patients experienced longer ICU and hospital stays, and more frequent adverse events like infection and pleural effusion.
- Risk factors identified: dominant right ventricle (OR 2.711) and higher peak CVP on POD 0 (OR 1.116).
Conclusions:
- The incidence of chylothorax after TCPC is lower than previously reported but significantly impacts survival.
- Dominant right ventricle and elevated post-operative day 0 CVP are significant risk factors for chylothorax.
- Improved management strategies are needed to mitigate the adverse effects of chylothorax on pediatric TCPC outcomes.
Abstract:
Background: Chylothorax is a severe complication after total cavopulmonary connection (TCPC) in children. This study was performed to evaluate the incidence, risk factors, and short- and long-term prognosis for chylothorax. Methods: We retrospectively reviewed the electronic records of patients who underwent TCPC between January 2008 and December 2020 in Fuwai Hospital. Patients were divided into two groups based on the occurrence of post-operative chylothorax. Univariate and multivariate analyses were performed to identify risk factors, and long-term survival was estimated by the Kaplan-Meier method. Results: Of 386 patients included in our study, chylothorax occurred in 60 patients (15.5%). Compared with the non-chylothorax group, the prevalence of prolonged intensive care unit (ICU) stay (p = 0.000) and post-operative hospital stay (p = 0.000) were greater in patients with chylothorax. Post-operative adverse events in terms of infection (p = 0.002), ascites (p = 0.001), prolonged pleural effusion (p = 0.000), and diaphragmatic paralysis (p = 0.026) were more frequent in chylothorax patients. The median follow-up duration was 4.0 (2.0, 6.8) years. The chylothorax group had significantly lower survival rates at 1 year (92.4 vs. 99.3%, p < 0.001) and 10 years (84.6 vs. 91.6%, p < 0.001), respectively. Having a right dominant ventricle [odds ratio (OR) = 2.711, 95% confidence interval (CI) = 1.285-5.721, p = 0.009] and a higher peak central venous pressure (CVP) on post-operative day (POD) 0 (OR = 1.116, 95% CI = 1.011-1.233, p = 0.030) were the risk factors for the development of chylothorax after TCPC operation. Conclusion: The incidence of chylothorax in patients undergoing TCPC is lower than previously reported but is associated with poor early- and long-term survival. Having a right dominant ventricle and a higher peak CVP on POD 0 are the risk factors for chylothorax after TCPC operation.
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