Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery

Ismail, Sameh R.; Kabbani, Mohamed S.; Najm, Hani K.; Shaath, Ghassan; Jijeh, Abdulraouf; Hijazi, Omar

doi:10.1016/j.jsha.2014.01.001

Cited by 23 publications

(32 citation statements)

References 24 publications

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“…[10] In our study, three patients died (8.5%), which was similar to previous studies that had mortality rates of between 6 and 21%. [1,9,12,13] The cause of death in our patients was likely multifactorial due to the unfavorable hemodynamics, sepsis, and multiple organ dysfunction.…”

Section: Discussionsupporting

confidence: 91%

“…Allen et al [9] reported an incidence rate of 1% in their study in 1979 and 1987 while the latest reported incidence rates were 3.5% by Chan et al [3] and 5% by Ismail et al [10] The higher rates were likely due to the increased complexity of the patients along with the number of singleventricle repairs and redo surgeries. [3] The incidence of chylothorax in our study population was 3.1%, which Five of these patients had HLHS, and four underwent redo surgeries.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, most of the published pediatric studies are also limited to small case series. [10] The optimal management of chylothorax is unclear because no prospective studies exist to aide in the choice of therapy since different protocols and strategies are followed in each center. [11,12] The primary modes of treatment include pleural space evacuation, the use of MCT oil-based formulas, enteric rest, and parenteral alimentation, [12,13] and these have shown a success rate of 77% within a maximum of 45 days, with an average time of approximately 12 days.…”

Section: Discussionmentioning

confidence: 99%

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Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada şilotoraksın insidansı, tedavi protokolleri ve pediatrik kardiyovasküler cerrahi sonrası erken dönem bulgular üzerindeki etkisi değerlendirildi. Ça lış ma pla nı: Haziran 2011 -Haziran 2014 tarihleri arasında kliniğimizde kalp ameliyatı geçiren 1123 pediatrik hastanın kayıtları retrospektif olarak incelendi. Ameliyat sonrası şilotoraks gelişen 35 hasta (19 erkek, 16 kız; ortanca yaş 240 gün; dağılım 5 gün-15 yıl) çalışmaya dahil edildi. Bul gu lar: Şilotoraks gelişimi en sık tek ventrikül tamirlerinde saptandı (n=11, %31). Bunu aortik ark tamiri (n=9, %25), Fallot tetralojisi (n=4, %11) atriyoventriküler septal defekt tamirleri (n= 4, %11), arteriyel switch ameliyatları (n=3, %8), ventriküler septal defekt tamirleri (n=2, %6) ve diğer ameliyatlar (n=2, %6) izledi. Ortanca şilotoraks drenaj süresi dokuz gün (dağılım 2-44 gün) idi. Beslenme yönetimi yağdan fakir diyet, orta zincirli yağ asitlerinden zengin enteral beslenme ve total parenteral beslenmeyi içerdi. On dört hastaya oktreotid, dört hastaya duktus torasikus ligasyonu ve dört hastaya plörodezis uygulandı. Dokuz hastada sepsis gözlendi ve üç hasta kaybedildi. So nuç:Pediatrik kardiyak cerrahi sonrası gelişen şilotoraks nadir olmayan bir komplikasyondur. En sık tek ventrikül tamiri sonrasında gelişir ve ameliyat sonrası klinik seyir ve morbidite üzerinde anlamlı etkiye sahiptir.Anah tarsöz cük ler: Kardiyak cerrahi; çocuklar; şilotoraks. ABSTRACT Background:This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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“…In our study population, the incidence of chylothorax was 1.1% over a 10-year period, which was slightly lower than the 1.18% of occurrence reported in the literature (for a population of 4,068 patients) (2,8,22). However, it is possible that the incidence is not related to the annual surgical volume.…”

Section: Discussioncontrasting

confidence: 66%

“…However, it is possible that the incidence is not related to the annual surgical volume. Usually, chylothorax appears between day 0-10 after injury to the thoracic duct, except in patients undergoing a vascular ring operation in which the surgical injury is certain (22). In the present study, the peak appearance of chylothorax was observed on the second postoperative day, which raises the possibility that chylothorax is a result of multiple precipitating factors presenting in the postoperative period.…”

Section: Discussionmentioning

confidence: 41%

Chylothorax after pediatric cardiac surgery complicates short-term but not long-term outcomes—a propensity matched analysis

Czobor¹,

Róth²,

Prodán³

et al. 2017

J. Thorac. Dis.

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Macronutrient Analysis of Modified‐Fat Breast Milk Produced by 3 Methods of Fat Removal

Barbas

O'Brien

Forbes

et al. 2019

J Parenter Enteral Nutr

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BackgroundInfants with chylothorax after congenital heart disease surgery are commonly treated using modified‐fat breast milk. The effect of fat removal on breast milk macronutrients remains unclear. We compared macronutrient content of breast milk with breast milk skimmed using 3 methods, including a novel device, a cream separator.MethodsThawed frozen breast milk samples from 30 women were defatted using refrigerated centrifuge, cream separator, and manual separation after refrigeration. We used standard assays to measure energy, protein, and fat content of breast milk samples.ResultsAll fat removal methods yielded skimmed breast milk with substantially lower fat and energy content. Mean energy content in breast milk skimmed by centrifuge (36.7 [SD 3.6] kcal/100 mL) was similar to that from cream separator (38.8 [3.5] kcal/100 mL). Both centrifuge and cream separator methods removed almost all fat and substantially more fat than the manual fat removal method. For unprocessed milk, energy and fat content estimated by creamatocrit was similar to reference method measurements; in skimmed milk, the creamatocrit significantly overestimated fat content. Mean protein content of skimmed breast milk was similar to unprocessed breast milk (mean 1.25 [0.31] g/100 mL).ConclusionBreast milk fat removal did not significantly alter protein levels. In skimmed breast milk, the overestimation of fat content using creamatocrit method suggests a need for more accurate bedside methods to assess macronutrient content. The similar macronutrient composition of breast milk skimmed by cream separator and centrifuge suggests the potential for cream separator use as a new, portable defatting method for hospitals and families.

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Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery

Abstract: Chylothorax after pediatric cardiac surgery is not a rare complication. It occurs more commonly with single ventricle repair and aortic arch repair surgeries, and has a significant impact on the postoperative course and post operative morbidity.

Cited by 23 publications

References 24 publications

Chylothorax following pediatric cardiac surgery

Chylothorax following pediatric cardiac surgery

Chylothorax after pediatric cardiac surgery complicates short-term but not long-term outcomes—a propensity matched analysis

Macronutrient Analysis of Modified‐Fat Breast Milk Produced by 3 Methods of Fat Removal

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