Postoperative chylothorax following congenital heart surgery: Incidence, risks, therapy, and possible mechanisms.
5 affiliations
- 1Department of Congenital and Pediatric Heart Surgery, German Heart Center, TUM University Hospital, Munich, Germany.
- 2Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
- 3Europäisches Kinderherzzentrum München, Munich, Germany.
- 4Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, TUM University Hospital, Munich, Germany.
- 5Department of Cardiovascular Surgery, German Heart Center, TUM University Hospital, Munich, Germany.
Abstract
Objective
To determine the incidence, risks factors, outcomes, and mechanisms of postoperative chylothorax (PCT) following congenital heart surgery.Methods
Among all patients who underwent congenital heart surgery between 2001 and 2024, those who developed PCT during the same hospitalization were identified. The prevalence of chylothorax was analyzed, along with associated procedures, risk factors, and hemodynamics.Results
Among 9892 congenital heart surgeries performed during the study period, 312 patients (3.2%) developed PCT. Patients with PCT had a higher proportion of males (64% vs 56%; P = .009), younger age at surgery (median, 0.6 years vs 1.2 years; P < .001), and lower weight at surgery (median, 6.1 kg vs 8.6 kg; P < .001) compared to those without PCT. Regarding surgical types, the most frequently performed operation was the Fontan procedure (20.5%), followed by repair of tetralogy of Fallot (TOF) with atrioventricular septal defect (11.8%), arterial switch operation (ASO), ventricular septal defect (VSD) closure, and aortic arch repair (10.0%). Younger age at operation (P < .001; hazard ratio [HR], 0.745), the Fontan procedure (P < .001; HR, 16.198), ASO, VSD closure, and aortic arch repair (P < .001; HR, 2.835) were strong risk factors for PCT. Postoperative lower mean arterial pressure and higher central venous pressure were associated with PCT in patients following the Fontan procedure and TOF repair.Conclusions
This large, single-center study of approximately 10,000 congenital heart surgeries reported a 3.2% incidence of PCT. The Fontan procedure had the highest incidence of PCT, followed by complex biventricular repair in neonates and young infants. Early postoperative lower mean arterial pressure and higher central venous pressure may trigger PCT.
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BibTeX
@article{schaeffer2026postoperative,
title = {{Postoperative chylothorax following congenital heart surgery: Incidence, risks, therapy, and possible mechanisms.}},
author = {Thibault Schaeffer and Verena Kunke and Jonas Palm and Andrea Amici and Teresa Lemmen and Christina Ruda and Nicole Piber and Muneaki Matsubara and Paul Philipp Heinisch and Alfred Hager and Peter Ewert and Jürgen Hörer and Masamichi Ono},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102062},
url = {https://europepmc.org/article/MED/42948120},
note = {CC BY},
}
RIS
TY - JOUR
TI - Postoperative chylothorax following congenital heart surgery: Incidence, risks, therapy, and possible mechanisms.
AU - Thibault Schaeffer
AU - Verena Kunke
AU - Jonas Palm
AU - Andrea Amici
AU - Teresa Lemmen
AU - Christina Ruda
AU - Nicole Piber
AU - Muneaki Matsubara
AU - Paul Philipp Heinisch
AU - Alfred Hager
AU - Peter Ewert
AU - Jürgen Hörer
AU - Masamichi Ono
PY - 2026
DA - 2026/08/18
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102062
UR - https://europepmc.org/article/MED/42948120
AB - Objective To determine the incidence, risks factors, outcomes, and mechanisms of postoperative chylothorax (PCT) following congenital heart surgery.Methods Among all patients who underwent congenital heart surgery between 2001 and 2024, those who developed PCT during the same hospitalization were identified. The prevalence of chylothorax was analyzed, along with associated procedures, risk factors, and hemodynamics.Results Among 9892 congenital heart surgeries performed during the study period, 312 patients (3.2%) developed PCT. Patients with PCT had a higher proportion of males (64% vs 56%; P = .009), younger age at surgery (median, 0.6 years vs 1.2 years; P < .001), and lower weight at surgery (median, 6.1 kg vs 8.6 kg; P < .001) compared to those without PCT. Regarding surgical types, the most frequently performed operation was the Fontan procedure (20.5%), followed by repair of tetralogy of Fallot (TOF) with atrioventricular septal defect (11.8%), arterial switch operation (ASO), ventricular septal defect (VSD) closure, and aortic arch repair (10.0%). Younger age at operation (P < .001; hazard ratio [HR], 0.745), the Fontan procedure (P < .001; HR, 16.198), ASO, VSD closure, and aortic arch repair (P < .001; HR, 2.835) were strong risk factors for PCT. Postoperative lower mean arterial pressure and higher central venous pressure were associated with PCT in patients following the Fontan procedure and TOF repair.Conclusions This large, single-center study of approximately 10,000 congenital heart surgeries reported a 3.2% incidence of PCT. The Fontan procedure had the highest incidence of PCT, followed by complex biventricular repair in neonates and young infants. Early postoperative lower mean arterial pressure and higher central venous pressure may trigger PCT.
SN - 2666-2736
ER -