TY - JOUR
T1 - Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion
AU - Lo Rito, Mauro
AU - Al-Radi, Osman O.
AU - Saedi, Arezou
AU - Kotani, Yasuhiro
AU - Ben Sivarajan, V.
AU - Russell, Jennifer L.
AU - Caldarone, Christopher A.
AU - Van Arsdell, Glen S.
AU - Honjo, Osami
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/5
Y1 - 2018/5
N2 - 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.
AB - 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.
KW - Fontan
KW - chylothorax
KW - pleural effusion
KW - predictors
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U2 - 10.1016/j.jtcvs.2017.11.046
DO - 10.1016/j.jtcvs.2017.11.046
M3 - Article
C2 - 29249497
AN - SCOPUS:85039454748
VL - 155
SP - 2069
EP - 2077
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 5
ER -