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VEPTR: Are We Reducing Respiratory Assistance Requirements?
Sarah B Nossov1, Evan Curatolo2, Robert M Campbell3
1Shriners Hospital for Children, Philadelphia, PA.
Journal of Pediatric Orthopedics
|April 12, 2017
Summary
Early thoracic reconstruction using the VEPTR device can improve respiratory status in children with thoracic insufficiency syndrome and early onset scoliosis. A significant subset of patients no longer require assisted ventilation after treatment.
Area of Science:
- Pediatric Orthopedics
- Thoracic Surgery
- Pulmonology
Background:
- Assisted Ventilation Rating (AVR) quantifies respiratory support needs in children with Thoracic Insufficiency Syndrome (TIS) and early onset scoliosis.
- The Vertical Expandable Prosthetic Titanium Rib (VEPTR) device is utilized for lung volume and growth enhancement in skeletally immature patients with TIS.
Purpose of the Study:
- To evaluate the impact of early thoracic reconstruction with VEPTR treatment on the respiratory status of pediatric patients.
- To determine if VEPTR treatment leads to improved or resolved need for assisted ventilation.
Main Methods:
- A multicenter study prospectively collected AVR ratings before and after VEPTR treatment.
- Included patients were under 10 years old at initial implant with at least a 2-year follow-up.
- Statistical analysis compared AVR changes in groups with stable, declined, or improved respiratory status.
Main Results:
- Out of 77 patients with abnormal AVR, 19 (24%) showed improvement, 9 (12%) deteriorated, and 49 (64%) remained unchanged.
- Patients who improved or remained stable had smaller preoperative major curves compared to those who deteriorated (P=0.014).
- Of those who improved, 16 (84.2%) achieved normal AVR, no longer requiring respiratory support.
Conclusions:
- Early thoracic reconstruction with VEPTR can lead to complete resolution of pulmonary support needs in a subset of patients.
- 89% of patients did not experience respiratory deterioration, and 24% showed positive AVR changes.
- VEPTR treatment offers a potential for significant respiratory improvement in pediatric patients with TIS and early onset scoliosis.