Postoperative Chylothorax Development Is Associated with Increased Incidence and Risk Profile for Central Venous Thromboses

Abstract

This study tested the hypothesis that pediatric patients who develop chylothorax (CTX) after surgery for congenital heart disease (CHD) have an elevated incidence and risk profile for central venous thrombosis (CVT). We evaluated 30 patients who developed CTX after surgery for CHD. All but one CTX patient were surgery-, anatomy-, and age-matched with two controls (NON-CTX) to compare their relative risk and incidence of CVT. Using conditional logistic regression analyses, CTX development was associated with significantly longer ventilator dependence (14.8 +/- 10.9 vs. 6.1 +/- 5.9 days, p = 0.003) and a non-significant trend towards more days of central venous catheters (CVC) (19.1 +/- 16.6 vs. 12.2 +/- 10.0 days; p = 0.16) when comparing the period prior to CTX development with the entire hospitalization in NON-CTX patients. CTX development was associated with a significantly elevated mortality risk (Odds Ratio 6.2, 95% CI 1.3-30.9). Minimum and mean daily central venous pressures were significantly higher in the CTX group. Post operative need for extracorporeal membrane oxygenation conferred an increased risk of CTX development in this sample of patients (Odds Ratio 9.9, 95% CI 2.2-44.8). Incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group. Prospective screening for CVT risk and formation, combined with early removal of CVC may help reduce the incidence of CTX.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…252 Multivariate analysis found only a higher central venous pressure to be related to the risk of chylothorax. Patients with significant drainage will have low measured levels of AT III, protein C, and protein S, creating a hypercoagulable state.…”

“…251 These effusions can drain significantly. Chylothoraxes are associated with an increased risk of thrombosis, 252 likely because of the loss of important proteins, including proteins C and S. In addition, loss of AT III can limit the effectiveness of heparin, which is often the first-line anticoagulant. Serious complications can include pulmonary artery thrombosis and cerebral sinovenous thrombosis.…”

Chylothorax after congenital diaphragmatic hernia repair: a population-based study

“…The association between increased central venous and pulmonary pressures and chylothorax occurrence has been previously described in pediatric cardiac surgery patients [17,18]. Evidence for this association has been the resolution of postcardiac surgery chylothorax after successful treatment of pulmonary hypertension with inhaled nitric oxide [8].…”

Konjenital kalp cerrahisi sonrası şilotoraks tanı ve tedavisine güncel yaklaşım

“…Postoperatif dönemde lenfatik sıvının kaybı birkaç farklı sistemi etkileyerek hastanın postoperatif iyileşme ve rehabilitasyon dönemini bozabilir. Ayrıca şilöz sıvının plevral boşlukta birikmesi hastanın solunum fonksiyonlarında bozulmaya yol açıp solunum yetmezliğine ve mekanik ventilatörden ayrılma güçlüğüne neden olabilir (13). Şilöz sıvı proteinden zengin olduğu kadar yağdan da zengindir.…”