Original articleCongenital heart surgeryPatients With Systemic Right Ventricle Are at Higher Risk of Chylothorax After Cavopulmonary Connections
Section snippets
Patients and Methods
The records of consecutive patients who underwent a superior cavopulmonary connection (SCPC) and a primary Fontan completion in our institution from January 2008 to December 2016 were reviewed. Patients older than 18 years of age or who underwent previous or further cardiac procedures in other institutions were excluded (n = 62). The study was approved by the Human Research Ethics Committee of The Royal Children’s Hospital Melbourne in Australia. Patients’ characteristics are reported in Table 1
Results
The rate of chylothorax after a CPC procedure was 19.7% (74 of 376): 15.6% (31 of 199) after SCPC and 24.3% (43 of 177) after Fontan completion. SCPC and Fontan completion were performed at a median age of 3.5 months (3.0 to 6.1 months) and 4.9 years (4.2 to 5.6 years), respectively. There were seven (2.4%) early deaths and 26 (9%) late deaths. Mean follow-up was 4.3 ± 0.1 years.
Comment
The mechanisms of failure of the Fontan circulation have not yet been clearly explained. In recent years, better imaging of the lymphatic circulation and improved understanding of the physiology of the thoracic duct have emphasized the lymphatic system abnormalities in patients with a Fontan circulation 12, 13. In the wake of these discoveries, it has been demonstrated that outcomes in patients undergoing Fontan completion were worse if chylothorax developed in the early postoperative period [9]
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