The incidences of chylothorax after major thoracic surgery have been reported to be 0.42 up to 2%. Chylothorax following internal thoracic artery (ITA) harvesting for coronary artery bypass (CAB) is an extremely rare subset of these cases with isolated case reports documented in the literature. After CABG, chylothorax could be a severe and aggravating complication. We present a series of chylothorax cases in a group of CAB patients and analyze trends of management.
A retrospective review of postoperative CAB chylothorax patients at one academic institution from 1986–2006 was performed. A total of 26,563 CAB procedures with ITA harvesting were performed from 1986 to 2006. Of this number, 6 (0.0003%) were diagnosed with postoperative chylothorax and 2 other patients were referred to the thoracic service from neighboring community hospitals. Chart reviews were conducted to acquire preoperative characteristics of the patients, the urgency of the case, timing of postoperative diagnosis of chylothorax, management decision and the postoperative hospital course.
Of the eight patients, six (75%) were male. The age range was from 55–79 years. The average time to presentation was 14 days (4–35days). Five (63%) patients were treated conservatively. Three (37%) patients underwent thoracic duct ligation after failure of conservative management which consisted of hyperalimentation and chest tube drainage. The average time for successful conservative treatment was 11.6 days. Earlier time of presentation as well as initial low output volume (≤500mL) were observed to be trends for successful conservative therapy although no statistical significance was achieved. Two (25%) patients managed nonsurgically died from other postoperative complications.
With an ever growing sicker CAB operative population, chylothorax resulting from ITA takedown becomes a significant complication when combined with other comorbidities. Early detection and prompt initiation of conservative management are key elements for successful outcomes. Surgical ligation should be considered when conservative treatment fails to yield early progress.
Suspicion of chylothorax after CABG warrants an expeditious diagnosis and treatment.
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