Background:
Chylothorax is a severe complication after total cavopulmonary connection (TCPC) in children. This study was performed to evaluate the incidence, risk factors, and short- and long-term prognosis for
chylothorax. Methods: We retrospectively reviewed the electronic records of patients who underwent TCPC between January 2008 and December 2020 in Fuwai Hospital. Patients were divided into two groups based on the occurrence of post-operative
chylothorax. Univariate and multivariate analyses were performed to identify risk factors, and long-term survival was estimated by the Kaplan-Meier method. Results: Of 386 patients included in our study,
chylothorax occurred in 60 patients (15.5%). Compared with the non-
chylothorax group, the prevalence of prolonged intensive care unit (ICU) stay (p = 0.000) and post-operative
hospital stay (p = 0.000) were greater in patients with
chylothorax. Post-operative adverse events in terms of
infection (p = 0.002),
ascites (p = 0.001), prolonged
pleural effusion (p = 0.000), and
diaphragmatic paralysis (p = 0.026) were more frequent in
chylothorax patients. The median follow-up duration was 4.0 (2.0, 6.8) years. The
chylothorax group had significantly lower survival rates at 1 year (92.4 vs. 99.3%, p < 0.001) and 10 years (84.6 vs. 91.6%, p < 0.001), respectively. Having a right dominant ventricle [odds ratio (OR) = 2.711, 95% confidence interval (CI) = 1.285-5.721, p = 0.009] and a higher peak central venous pressure (CVP) on post-operative day (POD) 0 (OR = 1.116, 95% CI = 1.011-1.233, p = 0.030) were the risk factors for the development of
chylothorax after TCPC operation. Conclusion: The incidence of
chylothorax in patients undergoing TCPC is lower than previously reported but is associated with poor early- and long-term survival. Having a right dominant ventricle and a higher peak CVP on POD 0 are the risk factors for
chylothorax after TCPC operation.