Pleural Drainage, Clinical Characteristics, and Management Strategies in the Perioperative Fontan Patient: A...

Area of Science:

• Pediatric Cardiac Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Prolonged pleural drainage and chylothorax are frequent complications following the Fontan operation in pediatric patients.
• These complications are linked to increased morbidity and mortality, necessitating effective management strategies.
• Current treatment approaches vary significantly across different medical centers.

Purpose of the Study:

• To investigate the incidence and characteristics of prolonged pleural drainage and chylothorax in pediatric Fontan patients.
• To identify predictors of chylothorax development post-Fontan operation.
• To analyze the impact of chylothorax on patient outcomes and resource utilization.

Main Methods:

• Retrospective multicenter observational cohort study involving 185 pediatric patients who underwent the Fontan operation between 2019 and 2021.
• Data collected from institutional records and the Pediatric Cardiac Critical Care Consortium (PC4).
• Statistical analysis to compare patients with and without chylothorax, and to develop a predictive model for chylothorax.

Main Results:

• Chylothorax occurred in 18% of patients, with prolonged chest tube drainage (>14 days) in 22%.
• Chylothorax was associated with lower preoperative ventricular end-diastolic pressures, increased chest tube utilization, longer ICU and hospital lengths of stay, and greater weight loss.
• Chest tube output >18.8 mL/kg/day on postoperative day 2 predicted chylothorax with an AUC of 0.73.

Conclusions:

• Postoperative chylothorax in Fontan patients is associated with significant increases in resource utilization and adverse outcomes.
• Early identification of chylothorax risk is possible using postoperative chest tube output.
• Standardizing management protocols and further research are needed to improve outcomes and reduce center-level variations.