Chylothorax after adult cardiac surgery: a comprehensive narrative review.

BACKGROUND

Chylothorax is a rare but serious complication of adult cardiac surgery, associated with respiratory compromise, metabolic derangements, and prolonged hospitalization. Its management remains challenging due to the lack of standardized guidelines and the complex anatomical variability of the thoracic duct.

METHODS

This narrative review synthesizes available literature on postoperative chylothorax in adults. A total of 58 published cases were analyzed to identify patterns of presentation, treatment strategies, and clinical outcomes. Descriptive and comparative statistical analyses were applied to explore correlations between chyle output volume and treatment success.

RESULTS

The majority of chylothoraces occurred after coronary artery bypass grafting, particularly in association with left internal mammary artery harvesting. Initial chyle output > 1000 ml/day was significantly associated with failure of conservative management (p = 0.0476). Conservative treatment, including drainage, nutritional modification (MCT diet or TPN), and somatostatin analogues, was successful in 48.3% of patients, especially when output decreased within 72 h. Surgical ligation, pleurodesis, or radiological embolization were required in higher-output or refractory cases. Early output trends were strong predictors of the need for escalation.

CONCLUSION

Postoperative chylothorax after adult cardiac surgery demands a pragmatic, volume-guided approach. Daily chyle output and early response to conservative therapy should guide decision-making. Conservative measures are appropriate in low- and intermediate-output cases, while early intervention is warranted in high-output or unresponsive cases. This review provides a clinically applicable framework for the management of this rare but impactful complication.