912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon's experience.

Area of Science:

• Cardiothoracic Surgery
• Pediatric Surgery
• Surgical Innovation

Background:

• Severe pectus excavatum (PE) is a common congenital chest wall deformity.
• Physiologic impairment is often associated with severe PE.
• Previous open surgical techniques involving extensive cartilage resection yielded inconsistent results.

Purpose of the Study:

• To evaluate the long-term outcomes of open surgical repair for severe pectus excavatum.
• To assess the impact of progressively less invasive surgical techniques on patient results.
• To analyze the effectiveness of modified cartilage resection and sternal stabilization.

Main Methods:

• A retrospective review of 912 patients with symptomatic PE undergoing open surgical correction by a single surgeon from 1969 to 2007.
• Documentation of patient demographics, presenting symptoms, surgical techniques (including varying degrees of costal cartilage resection and sternal osteotomy), and postoperative outcomes.
• Analysis of complications, pain levels, hospitalization duration, and patient-reported results.

Main Results:

• Surgical repair significantly improved symptoms like dyspnea, reduced endurance, tachypnea, and tachycardia in nearly all patients within 5 months.
• Minimally invasive techniques with reduced cartilage resection led to a threefold decrease in repair for recurrent deformities and mild protrusion.
• The last 537 patients experienced fewer complications, less severe pain, and better outcomes compared to earlier, more extensive repairs, with a mean follow-up of 7.6 years.

Conclusions:

• This series, the largest of its kind for open PE repair, demonstrates that progressively less extensive operative techniques yield favorable outcomes.
• The modified approach results in low morbidity, mild pain, shorter hospital stays, and excellent physiologic and cosmetic results.
• Suture reattachment of resected cartilage segments and sternal support struts contribute to improved patient recovery and long-term satisfaction.