Propranolol treatment for chylothorax after congenital cardiac surgery,The Journal of Thoracic and Cardiovascular Surgery

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Propranolol treatment for chylothorax after congenital cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2021-09-14 , DOI: 10.1016/j.jtcvs.2021.09.007
Rozelle Corda ₁ , Sophia Chrisomalis-Dring ₂ , Sarah Crook ₂ , Carrie J Shawber ₃ , June K Wu ₄ , Paul J Chai ₅

Affiliation

Objective

Postoperative chylothorax causes significant morbidities in pediatric patients with cardiac disease. New treatment approaches based on evolving understanding of underlying lymphatic dysfunction are being developed. We hypothesized that propranolol reduces morbidities and duration of chest tube requirement in high-output chylous effusion.

Methods

The postoperative courses of 50 pediatric patients with cardiac disease and high-output chylous effusion (control, n = 25; propranolol-treated, n = 25) were reviewed, including morbidities, length of hospitalization, and duration of chest tube requirement. Statistical analysis was performed using Welch's t test, Kruskal–Wallis tests for continuous variables, and chi-square and Fisher exact tests for categorical variables. Univariable logistic regression was used to determine predictors of response.

Results

Propranolol response was defined as 80% or more drainage reduction in 9 days or less. Treated patients were grouped into responders (<9 days) and nonresponders (>10 days). Neither initial amount of drainage (P = .12) nor day of propranolol initiation (P = .17) correlated with response. When compared with controls and nonresponders, responders had significantly fewer days with chest tube requirement (P < .01), infection (P < .0002), and thrombus (P = .005), and shorter hospitalization (P < .05). All patients had low serum albumin, although nonresponders had significantly decreased serum albumin when compared with responders and control patients (P < .002), and were more likely to receive albumin replacement (P < .01). Malnutrition was prevalent in all patient groups.

Conclusions

Responders to propranolol had significantly less morbidity and duration of chest tube requirement when compared with control patients and nonresponders. Nonresponders did not have worse outcomes than control patients. We conclude that propranolol may be an effective treatment of patients with refractory chylothorax.

中文翻译：

普萘洛尔治疗先天性心脏手术后乳糜胸

客观的

术后乳糜胸在患有心脏病的儿科患者中引起显着的发病率。正在开发基于对潜在淋巴功能障碍不断发展的理解的新治疗方法。我们假设普萘洛尔可降低高输出量乳糜积液中胸管需求的发病率和持续时间。

方法

回顾了 50 名患有心脏病和高排出量乳糜积液的儿科患者（对照组，n = 25；普萘洛尔治疗，n = 25）的术后病程，包括发病率、住院时间和胸管需求持续时间。使用 Welch 的t检验、连续变量的 Kruskal-Wallis 检验以及分类变量的卡方和 Fisher 精确检验进行统计分析。单变量逻辑回归用于确定反应的预测因子。

结果

普萘洛尔反应被定义为在 9 天或更短的时间内引流减少 80% 或更多。接受治疗的患者分为有反应者（<9 天）和无反应者（>10 天）。初始引流量 ( P = .12) 和普萘洛尔起始天数 ( P = .17) 均与反应无关。与对照组和无反应者相比，反应者需要胸管 ( P < .01)、感染 ( P < .0002) 和血栓 ( P = .005) 的天数显着减少，住院时间更短 ( P < .05)。所有患者的血清白蛋白均较低，尽管与应答者和对照患者相比，无应答者的血清白蛋白显着降低（P < .002)，并且更有可能接受白蛋白替代治疗 ( P < .01)。营养不良在所有患者组中都很普遍。