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.
The Annals of Thoracic Surgery
|October 27, 2009
Summary
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.
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