Traumatic chylothorax management post-coronary artery bypass grafting - A systematic review

Abstract

Introduction: Coronary artery bypass graft (CABG) surgery is performed globally around 400,000 times annually. Despite its benefits, CABG can lead to complications, including chylothorax, a rare condition where chyle accumulates in the pleural cavity due to thoracic duct trauma. Currently, there are no international guidelines for traumatic chylothorax management post-CABG. This is the first systematic review to provide a comprehensive overview of the current state of management for chylothorax post-CABG. Methods: This systematic review was conducted by searching EMBASE, Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion criteria focused on studies addressing post-CABG chylothorax management and reporting clinical outcomes. Data was extracted from 11 studies focusing on graft type, complications and management strategies. Results: This review included 11 case report studies with 14 cases of post-CABG chylothorax. Conservative management was attempted in all cases, with varying components such as total parenteral nutrition, nil by mouth, octreotide and low-fat diets. High-output chylothorax (>1000 mL/day) often necessitated surgical intervention after an average of 12.5 days of conservative management. Surgical approaches included thoracic duct ligation, embolisation and pleurodesis. Surgical ligation was effective in three cases, while thoracic duct embolisation was successful in one case. Conclusions: Chylothorax post-CABG is managed initially with conservative strategies, but high-output cases often necessitate surgical intervention. This review highlights the need for standardised guidelines, regarding the timing of surgical escalation and the use of octreotide and somatostatin. Further research should focus on higher-powered studies to validate these findings and establish clinical guidelines for managing chylothorax post-CABG.