Modified Ravitch Procedure for Pectus Excavatum Combined With Complex Cardiac Surgery

Area of Science:

• Cardiothoracic Surgery
• Thoracic Surgery
• Congenital Heart Surgery

Background:

• Pectus excavatum frequently co-occurs with connective tissue disorders and congenital heart disease, often requiring surgical repair.
• The optimal surgical strategy for pectus excavatum in patients undergoing cardiac surgery remains debated.
• Simultaneous repair offers a potential solution to manage both conditions concurrently.

Purpose of the Study:

• To evaluate the safety and efficacy of a simultaneous modified Ravitch procedure for pectus excavatum repair during complex cardiac surgery.
• To assess outcomes in patients with pectus excavatum, particularly those with connective tissue disorders or prior failed pectus repairs.
• To determine the feasibility of combining pectus excavatum repair with major cardiac procedures.

Main Methods:

• A case series of 11 patients undergoing simultaneous pectus excavatum repair (modified Ravitch) and complex cardiac surgery between January 2012 and January 2020.
• Patients had a median age of 35 years, with 73% having connective tissue disorders and 18% recurrent pectus excavatum.
• Concomitant cardiac procedures included aortic root replacement and mitral valve repair.

Main Results:

• No in-hospital or follow-up deaths were recorded.
• There were no reoperations for bleeding, tamponade, or wound infections.
• Patients experienced short intensive care unit (82 hours) and hospital stays (9.1 days) with no prolonged ventilation or reintubation.

Conclusions:

• Concurrent pectus excavatum repair during cardiac surgery using a modified Ravitch technique is safe and feasible.
• This combined approach can be effectively managed by a multidisciplinary team.
• Consideration should be given to simultaneous repair for patients with multiple surgical indications.