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Percutaneous Thoracic Duct Externalization and Autotransfusion in Patients With Lymphatic Failure Due to Elevated
Yoav Dori1,2, Erin Pinto1,2, Lauren Biroc1,2
1Division of Cardiology (Y.D., E.P., L.B., M.J.G., R.C., J.T., M.L.O.B., D.V., A.G.DW., E.F., R.S., J.J.R., C.L.S.), Children's Hospital of Philadelphia, PA.
Background:
External drainage of the thoracic duct can temporarily reduce tissue congestion and improve symptoms in patients with heart failure. However, loss of fluid limits the duration of this approach. Here, we report on our initial experience with thoracic duct drainage and autotransfusion in patients with elevated central venous pressure.
Methods:
This is a retrospective review of medical records of 8 patients who underwent percutaneous thoracic duct drainage with autotransfusion as part of their medical care. We reviewed clinical and procedural outcomes, laboratory data, and imaging.
Results:
In 5 (62.5%) patients, central venous pressure was elevated secondary to congenital heart disease, 1 (12.5%) had a lymphatic conduction disorder and trisomy 21, 1 (12.5%) had a lymphatic conduction disorder with Noonan syndrome and congenital heart disease, and 1 (12.5%) patient had severe chronic lung disease due to prematurity. Median central venous pressure was 15.5 mm Hg (range, 12-28), and all patients presented with severe multicompartment lymphatic failure including plastic bronchitis (12.5%), pleural effusions (37.5%), protein-losing enteropathy (62.5%), ascites (75%), and anasarca (100%). Over 7 (87.5%) patients survived to decannulation, and the median duration of autotransfusion was 11.5 days (range, 6-126). There was a significant reduction in creatinine from a median of 0.63 (0.3-2.4) to 0.36 (0.16-0.8) mg/dL (P=0.017). There was also a significant reduction in weight (P=0.017) and drainage output (P=0.017). There were no intraprocedural or autotransfusion-related deaths.
Conclusions:
Thoracic duct drainage with autotransfusion can improve fluid status and end-organ function without significant complications and presents a new therapeutic option. Further studies are needed to better define indications for this procedure and long-term outcomes.
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