Mediastinal Drain Removal as a Novel Strategy for Refractory High-Output Chylothorax Following Congenital Heart Surgery

BACKGROUND High output chylothorax is a significant complication following congenital heart surgery, with limited effective treatment options when refractory to medical therapy. We describe the association between mediastinal drain removal and resolution of this condition. METHODS We retrospectively identified neonates with postoperative high output chylothorax refractory to medical therapy at a single tertiary pediatric cardiac center between 2021 and 2026. Six patients underwent mediastinal drain removal, three accidentally and three electively. Clinical characteristics, chylous output, and outcomes following drain removal were reviewed. RESULTS Five of the six patients had undergone a Norwood procedure. Removal of the mediastinal drain resulted in complete resolution in four patients and marked reduction followed by resolution in the other two. Two patients developed small pleural collections requiring temporary pigtail drainage. No patient developed chylopericardium or hemodynamic compromise following drain removal. CONCLUSIONS Mediastinal drain removal was associated with complete resolution or marked reduction of refractory high output chylothorax in all six patients. These observations suggest that mediastinal drains may perpetuate lymphatic leakage in selected patients. Elective removal of mediastinal drains may represent a novel management strategy for this condition.