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Chylothorax After Heart Surgery in Children

Juliane Kuster Bauer1, Nathalia Hocama1, Anna Clara Traub1

  • 1Pequeno Príncipe Hospital, Desembargador Motta st., 80.250-060, Curitiba, PR, 1070, Brasil.

Pediatric Cardiology
|August 10, 2023
PubMed

Insights

Chylothorax after pediatric cardiac surgery is linked to genetic syndromes, longer bypass times, fluid overload, and SIRS. Early identification of these risk factors can reduce associated mortality and infection rates.

Area of Science:

  • Pediatric Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Chylothorax, a complication of thoracic duct injury during pediatric cardiac surgery, leads to significant morbidity and mortality.
  • Increased resource utilization is associated with chylothorax, necessitating a deeper understanding of its risk factors and outcomes.
  • The incidence of chylothorax post-pediatric cardiac surgery has shown an upward trend in recent years.

Purpose of the Study:

  • To identify risk factors, clinical manifestations, complications, and treatment outcomes of chylothorax in pediatric cardiac surgery patients.
  • To analyze the distribution and incidence of chylothorax in a tertiary pediatric hospital setting.
  • To evaluate the impact of chylothorax on patient mortality and morbidity.

Main Methods:

  • Retrospective quantitative study analyzing medical records of 166 patients with chylothorax and 166 matched controls.
  • Data collected between January 2014 and December 2020 from a tertiary pediatric hospital in southern Brazil.
  • Multivariate analysis and sensitivity analysis were employed to identify risk factors and compare outcomes based on chylothorax output.

Main Results:

  • Identified risk factors for chylothorax include genetic syndromes (OR 2.298), prolonged cardiopulmonary bypass (>120 min) (OR 2.410), postoperative fluid overload (OR 1.110), and SIRS (OR 2.527).
  • Patients with chylothorax experienced a two-fold increase in mortality (p=0.021) and a higher incidence of infection (34.4%, p<0.001).
  • High-output chylothorax (>20 mL/kg) was associated with unfavorable outcomes.

Conclusions:

  • Genetic syndromes, prolonged cardiopulmonary bypass, fluid overload, and SIRS are significant risk factors for chylothorax post-pediatric cardiac surgery.
  • Chylothorax significantly increases mortality and infection rates in this patient population.
  • Early recognition of hemodynamic alterations and risk factors is crucial for mitigating morbidity and mortality associated with chylothorax.

Keywords:
Cardiac surgeryChylothoraxCongenital heart diseasePediatrics

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