Surgery for recurrent pectus deformities
Theresa D Luu1, Brian E Kogon, Seth D Force
1Department of Surgery, Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Adults with severe, asymmetric pectus deformities (pectus index > 4.0) may have higher recurrence rates after the Nuss procedure. The modified Ravitch repair might be a better initial choice for these patients, with reoperations yielding excellent outcomes.
Area of Science:
- Thoracic surgery
- Adult reconstructive surgery
- Chest wall deformities
Background:
- Pectus repair in adults presents unique challenges.
- The modified Ravitch procedure is a standard surgical approach.
- Minimally invasive Nuss procedure is increasingly used in adults, though data is limited.
Purpose of the Study:
- Identify patient characteristics associated with increased risk of pectus deformity recurrence.
- Evaluate management strategies for recurrent pectus defects in adults.
Main Methods:
- Retrospective review of adult patients (>16 years) undergoing primary or recurrent pectus repair from 1999-2006.
- Analysis of patient demographics, deformity type, surgical procedures, and recurrence rates.
Main Results:
- Forty-eight adult patients underwent pectus repair; 13 experienced recurrence.
- Recurrence was more common after Nuss procedures (8/13) compared to modified Ravitch (5/13).
- Patients with recurrence had severe deformities (pectus index > 4.0) and often asymmetric defects; reoperation yielded >90% good/excellent results.
Conclusions:
- Adults with severe (PI > 4.0) and asymmetric pectus deformities are at higher risk of recurrence following Nuss procedure.
- Modified Ravitch repair may be preferable for these specific adult pectus deformities.
- Reoperative pectus repair in adults is safe and effective, achieving excellent outcomes.
Background:
Pectus repair in adults can be challenging. Standard repair has been the modified Ravitch procedure. More recently the minimally invasive Nuss procedure, used exclusively in children, has been introduced for correction of pectus deformities in adults. There is a paucity of data on which procedure is most appropriate for adults and even less information on the most appropriate operation for pectus recurrence in adults. The purpose of this study is to determine if any specific patient characteristic exists that places patients at an increased risk for recurrence and describe our management of recurrent pectus defects in adults.
Methods:
We retrospectively reviewed the records of all patients (>16 years of age) who underwent primary or recurrent repair of pectus deformities from April 1999 through December 2006.
Results:
Forty-eight patients, 37 (77%) men and 11 women, underwent pectus repair with a median age of 28 years (range, 16 to 54 years). Indication for initial repair was pectus excavatum in 39 (81%) and pectus carinatum in 9. The primary procedure was a modified Ravitch repair in 40 patients and a Nuss procedure in 8. Thirteen patients (27%) underwent reoperation for recurrence; 8 (62%) patients had undergone a previous Nuss procedure and 5 had a modified Ravitch repair. All reoperative patients had a primary pectus index (PI) greater than 4.0, while 8 (62%) also had an asymmetrical defect. All failed Nuss procedure patients underwent a modified Ravitch repair for correction, while the recurrent open repair patients required complex reconstructions. Results were good or excellent in greater than 90% of patients undergoing a reoperative procedure.
Conclusions:
Adults with severe pectus deformities (PI > 4.0) and asymmetric defects are at a greater risk of recurrence after a Nuss procedure. These patients may better be served with a modified Ravitch repair initially. Reoperation for failed pectus repair in adults can be performed safely with outstanding results.
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