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A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair
C L Willekes1, C L Backer, C Mavroudis
1Department of Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
Insights
Surgical repair of pectus deformities using a vertical midline approach yields excellent long-term results. Utilizing a temporary sternal bar significantly improves outcomes compared to repairs without a bar.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Surgery
- Congenital Heart Surgery
Background:
- Pectus excavatum and pectus carinatum are common chest wall deformities.
- Surgical correction is often necessary for functional and cosmetic reasons.
- The vertical midline approach has been utilized for pectus deformity repair.
Purpose of the Study:
- To evaluate the operative experience and long-term outcomes of pectus deformity repair using a vertical midline approach.
- To assess the efficacy of a temporary sternal bar in pectus repair.
- To determine the safety and feasibility of simultaneous pectus and intracardiac repair.
Main Methods:
- A retrospective review of 120 children undergoing pectus deformity repair between 1972 and 1998.
- Surgical technique involved a vertical midline incision, subperichondrial resection of deformed cartilages, and anterior sternal osteotomy.
- Patients were divided into groups with and without a temporary retrosternal metal bar, and outcomes were assessed by patients and parents.
Main Results:
- 111 cases of pectus excavatum and 9 of pectus carinatum were repaired.
- 14 children (11.5%) had associated congenital heart defects; 9 underwent simultaneous pectus and intracardiac repair.
- Excellent or good results were achieved in 97% of patients who had a sternal bar, versus 52% without a bar (p = 0.004).
Conclusions:
- The vertical midline approach provides excellent long-term results for pectus excavatum and carinatum repair.
- The use of a temporary sternal bar is associated with superior outcomes.
- Concomitant repair of congenital heart defects and pectus deformity can be performed successfully without increased morbidity.
Background:
We reviewed our operative experience and long-term results with repair of pectus excavatum and carinatum deformities through a vertical midline approach, including those cases with simultaneous intracardiac repair.
Methods:
From 1972 through 1998, 120 children underwent pectus deformity repair. Operative technique used a vertical midline incision with subperichondrial resection of deformed cartilages and an anterior sternal osteotomy. Thirty-five patients had a temporary metal bar for retrosternal support for 6 months; 85 underwent repair without a bar. Patients and parents were asked to assess the outcome after pectus repair as poor, fair, good, or excellent.
Results:
There were 94 male and 26 female patients (mean age, 8.4 years; range, 3 to 21 years). There were 111 cases of pectus excavatum and 9 of pectus carinatum. Fourteen children (11.5%) had an associated congenital heart defect; 9 patients had simultaneous pectus and intracardiac repair. One patient was referred for emergent open heart repair and pectus repair after attempted "Nuss" repair resulted in a perforated right atrium, perforated right ventricle, and partially disrupted tricuspid valve apparatus. There were no deaths and only one significant complication, which required a return to the operating room for bleeding. Morbidity was not higher in patients with simultaneous intracardiac repair. Long-term follow-up was established in 83% of patients. Results were classified as excellent in 64 patients (64%), good in 25 (25%), fair in 8 (8%), and poor in 3 (3%). Thirty (86%) of 35 patients with a sternal bar had excellent results versus 34 (52%) of 65 without a bar (p = 0.004); 97% of patients who underwent repair with a sternal bar classified the result as excellent or good.
Conclusions:
Long-term results of pectus excavatum and carinatum repair through a vertical midline approach are excellent. Outcome with a temporary sternal bar is superior to outcome without a bar. Concomitant repair of congenital heart defects and pectus deformity may be performed successfully without additional morbidity.