The Editor,
We have read with great interest the article by Waikar et al.[1] and we have to congratulate them for their successful result. The aim of our brief comment is to highlight the key points for the prevention and treatment of this complication.
According to our experience, we suggest that the surgeon should maximize the left internal mammary artery conduit's length at the proximal end of the pedicle.[2] Damage to lymphatic channels during LIMA harvesting by electrocautery as already stated by the authors is the main destructive mechanism. Another probable cause is the division of the thymus gland and damage to the thymic lymphatic channels by electrocautery, in cases like aortic or mitral valve replacement when LIMA is not involved. Conservative treatment should start immediately upon diagnosis and almost always eliminates the need for surgical intervention.[3]
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Conflicts of interest
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References
- 1.Waikar HD, Kamalaneson P, Mohamad Zamri MS, Jayakrishnan AG. Chylothorax after off-pump coronary artery bypass graft surgery: Management strategy. Ann Card Anaesth. 2018;21:300–3. doi: 10.4103/aca.ACA_212_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Altun G, Pulathan Z, Kutanis D, Hemsinli D, Erturk E, Civelek A, et al. Conservative management of chylothorax after coronary artery bypass grafting. Tex Heart Inst J. 2015;42:148–51. doi: 10.14503/THIJ-13-3532. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Barbetakis N, Xenikakis T, Efstathiou A, Fessatidis I. Successful octreotide treatment of chylothorax following coronary artery bypass grafting procedure. A case report and review of the literature. Hellenic J Cardiol. 2006;47:118–22. [PubMed] [Google Scholar]