Risk factors for chylothorax and persistent serous effusions after congenital heart surgery
Raatz A, Schöber M, Zant R, Cesnjevar R, Rüffer A, Purbojo A, Dittrich S, Alkassar M (2019)
Publication Type: Journal article
Publication year: 2019
Journal
Book Volume: 56
Pages Range: 1162-1169
Journal Issue: 6
DOI: 10.1093/ejcts/ezz203
Abstract
OBJECTIVES: This study evaluated the various risk factors for chylothorax and persistent serous effusions (>7 days) after congenital heart surgery and developed equations to calculate the probability of their occurrence. METHODS: We performed a retrospective review of different medical databases at the University Hospital of Erlangen between January 2014 and December 2016. Full model regression analysis was used to identify risk factors, and prediction algorithms were set up to calculate probabilities. Discriminative power of the models was checked with the help of C-statistics. RESULTS: Of 745 operations on 667 patients, 68 chylothoraxes (9.1%) and 125 persistent pleural effusions (16.8%) were diagnosed. Lowest temperature [P = 0.043; odds ratio (OR) 0.899], trisomy 21 (P = 0.001; OR 5.548), a higher vasoactive inotropic score on the day of surgery (P = 0.001; OR 1.070) and use of an assist device (P = 0.001; OR 5.779) were significantly associated with chylothorax. Risk factors for persistent serous effusions were a given or possible involvement of the aortic arch during the operation (P = 0.000; OR 3.982 and 2.905), univentricular hearts (P = 0.019; OR 2.644), a higher number of previous heart operations (P = 0.014; OR 1.436), a higher vasoactive inotropic score 72 h after surgery (P = 0.019; OR 1.091), a higher central venous pressure directly after surgery (P = 0.046; OR 1.076) and an aortic cross-clamp time >86 min (P = 0.023; OR 2.223), as well as use of an assist device (P = 0.002; OR 10.281). The prediction models for both types of effusions proved to have excellent discriminative power. CONCLUSIONS: Persistent serous effusion is associated with a higher vasoactive inotropic score 72 h after surgery, an aortic cross-clamp time >86 min and elevated central venous pressure directly after surgery, which, in combination, potentially indicate cardiac stress. The developed logistic algorithm helps to estimate future likelihood.
Authors with CRIS profile
Anna Heyn
Professur für Kinderkardiologie
Robert Cesnjevar
Professur für Herzchirurgie mit dem Schwerpunkt Kinderherzchirurgie
Ariawan Purbojo
Department of Paediatric Cardiac Surgery
Sven Dittrich
Department of Paediatric Cardiology
Involved external institutions
Germany (DE)How to cite
APA:
Raatz, A., Schöber, M., Zant, R., Cesnjevar, R., Rüffer, A., Purbojo, A.,... Alkassar, M. (2019). Risk factors for chylothorax and persistent serous effusions after congenital heart surgery. European Journal of Cardio-Thoracic Surgery, 56(6), 1162-1169. https://doi.org/10.1093/ejcts/ezz203
MLA:
Raatz, Anna, et al. "Risk factors for chylothorax and persistent serous effusions after congenital heart surgery." European Journal of Cardio-Thoracic Surgery 56.6 (2019): 1162-1169.
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