Mauro Lo Rito1, Osman O Al-Radi2, Arezou Saedi3, Yasuhiro Kotani4, V Ben Sivarajan5, Jennifer L Russell6, Christopher A Caldarone7, Glen S Van Arsdell7, Osami Honjo8. 1. Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy. 2. Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia. 3. Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. 4. Department of Cardiovascular Surgery, Okayama University, Okayama, Japan. 5. Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. 6. Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. 7. Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 8. Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: osami.honjo@sickkids.ca.
Abstract
BACKGROUND: We hypothesized that chylothorax could be a sign of intolerance to the Fontan physiology, and thus patients who develop chylothorax or pleural effusion have worse medium-term to long-term survival. METHODS: A total of 324 patients who underwent the Fontan operation between 2000 and 2013 were included. Chylothorax was defined as ≥5 mL/kg/day of chylomicron-positive chest drainage fluid no earlier than postoperative day 5 or drainage with >80% lymphocytes. Outcomes were compared between the chylothorax and non-chylothorax groups by the Kaplan-Meier method and log-rank test. Independent predictors of chylothorax and number of days of any chest drainage were analyzed with multivariable logistic regression and multivariable generalized negative binomial regression for count data, respectively. RESULTS: Chylothorax occurred in 78 patients (24%). Compared with the non-chylothorax group, the chylothorax group had a longer duration of chest tube requirement (median, 18 days vs 9 days; P < .000) and a longer length of hospital stay (median, 19 days vs 10 days; P < .000). Eight patients (10.3%) required thoracic duct ligation. The chylothorax group had lower freedom from death (P = .013) and from composite adverse events (P = .021). No predictor was found for chylothorax. Pulmonary atresia (P = .031) and pre-Fontan pulmonary artery pressure (P = .01) were predictive of prolonged pleural effusion (>14 days). CONCLUSIONS: Occurrence of chylothorax following the Fontan operation can be a marker of poorer medium-term clinical outcomes. It is difficult to predict occurrence of chylothorax owing to its multifactorial nature and involvement of lymphatic compensatory capacity that is unmasked only after the Fontan operation.
BACKGROUND: We hypothesized that chylothorax could be a sign of intolerance to the Fontan physiology, and thus patients who develop chylothorax or pleural effusion have worse medium-term to long-term survival. METHODS: A total of 324 patients who underwent the Fontan operation between 2000 and 2013 were included. Chylothorax was defined as ≥5 mL/kg/day of chylomicron-positive chest drainage fluid no earlier than postoperative day 5 or drainage with >80% lymphocytes. Outcomes were compared between the chylothorax and non-chylothorax groups by the Kaplan-Meier method and log-rank test. Independent predictors of chylothorax and number of days of any chest drainage were analyzed with multivariable logistic regression and multivariable generalized negative binomial regression for count data, respectively. RESULTS: Chylothorax occurred in 78 patients (24%). Compared with the non-chylothorax group, the chylothorax group had a longer duration of chest tube requirement (median, 18 days vs 9 days; P < .000) and a longer length of hospital stay (median, 19 days vs 10 days; P < .000). Eight patients (10.3%) required thoracic duct ligation. The chylothorax group had lower freedom from death (P = .013) and from composite adverse events (P = .021). No predictor was found for chylothorax. Pulmonary atresia (P = .031) and pre-Fontan pulmonary artery pressure (P = .01) were predictive of prolonged pleural effusion (>14 days). CONCLUSIONS: Occurrence of chylothorax following the Fontan operation can be a marker of poorer medium-term clinical outcomes. It is difficult to predict occurrence of chylothorax owing to its multifactorial nature and involvement of lymphatic compensatory capacity that is unmasked only after the Fontan operation.
Authors: Aaron W Eckhauser; Maria I Van Rompay; Chitra Ravishankar; Jane W Newburger; S Ram Kumar; Christian Pizarro; Nancy Ghanayem; Felicia L Trachtenberg; Kristin M Burns; Garick D Hill; Andrew M Atz; Michelle S Hamstra; Mjaye Mazwi; Patsy Park; Marc E Richmond; Michael Wolf; Jeffrey D Zampi; Jeffrey P Jacobs; L LuAnn Minich Journal: Cardiol Young Date: 2019-11-26 Impact factor: 1.093
Authors: Reena M Ghosh; Heather M Griffis; Andrew C Glatz; Jonathan J Rome; Christopher L Smith; Matthew J Gillespie; Kevin K Whitehead; Michael L O'Byrne; David M Biko; Chitra Ravishankar; Aaron G Dewitt; Yoav Dori Journal: J Am Heart Assoc Date: 2020-03-30 Impact factor: 5.501