Management Options for Chylothorax After Vascular Ring Repair: Retrospective, Multicenter Cohort in the United States, 2021-2023.

OBJECTIVES

Chylothorax after vascular ring (VR) repair is likely secondary to direct injury to the lymphatic collection system and may benefit from tailored management. We have reviewed the management of patients with chylothorax following VR repair and compared the approaches to chylothorax care after all other cardiac surgeries.

DESIGN

Retrospective multicenter cohort.

SETTING

Ten pediatric cardiac surgical centers in the United States.

PATIENTS: Children with chylothorax after VR repair at participating pediatric cardiac surgical centers from 1/1/2021-12/31/2023. Analysis was stratified by chylothorax patients with VR surgery vs all other cardiac surgeries.

RESULTS

Overall, 45 patients had chylothorax following VR repair (45/340, 13.2%) in comparison to 384 patients who had chylothorax following all cardiac surgeries (including VR repair and Fontan procedure) (384/8,494, 4.5%). Compared with all other cardiac surgeries, a higher proportion of VR patients, than other cardiac surgical cases, underwent invasive lymphatic intervention including thoracic duct ligation, embolization, and pleurodesis (10/45 vs. 19/314. p = 0.001) and at an earlier median interval from index surgery (3.5 vs. 28 d, p < 0.001). The 10 patients with VR who underwent a lymphatic intervention had higher chest tube output on postoperative days (PODs) 2 (9.2 vs. 2.6 mL/kg/d, p = 0.005) and 3 (4.9 vs. 0.6 mL/kg/d, p = 0.002) compared with those who resolved without an invasive lymphatic intervention. Following lymphatic intervention, chylothorax resolved a median of 1 day later and there were 0 of 10 procedure-related complications.

CONCLUSIONS

Patients with chylothorax after VR more commonly undergo invasive intervention when compared with those with other surgeries. Chest tube output on PODs 2 and 3 may help differentiate VR patients who will need invasive intervention. Chylothorax resolves soon after invasive intervention in VR patients, and in our cohort of 10 there were no procedural-related complications.