Pleural Drainage, Clinical Characteristics, and Management Strategies in the Perioperative Fontan Patient

link.springer.com January 23, 2025

Prolonged pleural drainage and chylothorax are common in postoperative Fontan patients and are associated with increased morbidity and mortality. Multiple medical and interventional treatment strategies exist and vary between centers.

This is a retrospective multicenter observational cohort study of pediatric patients who underwent Fontan operation at 8 pediatric cardiac surgical institutions from 1/1/2019 to 12/31/2021. Data were obtained from institutional records and collected from the Pediatric Cardiac Critical Care Consortium (PC4).

185 patients underwent Fontan operation with median age of 3.8 years.

Chest tube drainage for > 14 days occurred in 40 patients (22%).

Chylothorax occurred in 33 patients (18%, incidence 9.1–26.2% across centers). Compared to non-chylothorax patients, those with chylothorax had lower preoperative ventricular end diastolic pressures (8 vs. 9 mm Hg, p = 0.019), greater chest tube utilization (13 vs. 7 days, p = < 0.001), ICU LOS (7 vs. 4 days, p = 0.001), hospital LOS (12 vs. 9 days, p < 0.001), and more weight loss (− 2.7% vs. 0.8%, p = 0.019).