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Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum
Awais Ashfaq1, Staci Beamer1, MennatAllah M Ewais1
1Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Background:
Minimally invasive repair of pectus excavatum (MIRPE) has been extended to repair of defects in adults, with reported higher complication rates and outcome failures. The optimal revision for a prior failed MIRPE in an adult has not been identified. We review our experience for this adult population.
Methods:
A retrospective review was performed of 129 patients (age ≥18 years) who underwent revision after a failed pectus excavatum (PE) repair from December 2010 through December 2016.
Results:
In total, 47 of the 129 (36%) revision patients had a prior failed MIRPE, with 98% presenting for revision because of inadequate correction after their initial repair. The median age was 28 years (range, 18 to 54 years), and 77% were men. Thirty-one (66%) patients had indwelling pectus support bars at the revision procedure. Mean time from initial MIRPE to the revision procedure was 3.34 ± 2.9 years. A modified MIRPE was successful in 39 (83%) patients. Hybrid repair with the addition of osteotomy cuts and/or titanium plating was required in 8 patients for an adequate revision. Multiple (2 bars, 62%; 3 bars, 38%), shorter (median, 13.5 inches versus 15.0 inches) bars were used for the revision versus earlier repair. Substantial lysis of intrathoracic adhesions was required in 40 (85%) patients, with a median operative time for revision MIRPE of 169 ± 66 minutes; median operative time for hybrid procedures, 314 ± 74 minutes.
Conclusions:
A modified MIRPE can be successfully used in most adults to revise a failed prior MIRPE.
Insights
Revision of failed minimally invasive repair of pectus excavatum (MIRPE) in adults is feasible. A modified MIRPE technique successfully treated most patients, offering a viable solution for pectus excavatum revision.
Area of Science:
- Thoracic surgery
- Adult reconstructive surgery
Background:
- Minimally invasive repair of pectus excavatum (MIRPE) is used in adults, but higher complication and failure rates are reported.
- Optimal revision strategies for failed MIRPE in adults remain unclear.
Purpose of the Study:
- To review the experience with revision surgery after failed pectus excavatum repair in adults.
- To evaluate the efficacy of modified MIRPE for revision procedures.
Main Methods:
- Retrospective review of 129 adult patients (≥18 years) undergoing revision for failed pectus excavatum repair (December 2010-December 2016).
- Analysis of prior MIRPE failures, revision techniques (modified MIRPE, hybrid repair), and outcomes.
Main Results:
- 36% of revision patients (47/129) had prior failed MIRPE, primarily due to inadequate correction.
- Modified MIRPE was successful in 83% (39/47) of patients; 8 required hybrid repair with osteotomy/plating.
- Revision often involved lysis of adhesions and use of multiple, shorter support bars.
Conclusions:
- Modified MIRPE is a successful approach for revising prior failed MIRPE in adult patients.
- Hybrid repair may be necessary for complex cases requiring osteotomy or plating.
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