Pectus Excavatum in Cardiac Surgery Patients

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Congenital Heart Disease

Background:

• Pectus excavatum often coexists with congenital heart disease and connective tissue disorders necessitating cardiac surgery.
• The condition may be incidentally found during cardiac repair or develop/worsen post-cardiac surgery.
• This review provides essential background for surgeons on the physiological impact, repair indications, and strategies for pectus excavatum in cardiac surgery patients.

Purpose of the Study:

• To equip cardiac and congenital surgeons with knowledge regarding pectus excavatum in the context of cardiac surgery.
• To review the physiological impact, indications for repair, and repair strategies for pectus excavatum.
• To discuss outcomes of pectus repair in patients undergoing cardiac surgery.

Main Methods:

• A comprehensive literature review was conducted.
• Keywords included pectus excavatum, pectus repair, and cardiac/congenital heart surgery.
• The PubMed database was utilized for the literature search.

Main Results:

• Pectus repair carries low complication risks in experienced hands, yielding cardiopulmonary benefits and symptom relief.
• Concomitant pectus and cardiac surgery is advisable with experienced pectus repair teams, especially considering the impact of bypass on pectus.
• Strategies like delayed sternal closure for instability and pericardial reconstruction or hybrid approaches for post-cardiac surgery repair are effective.

Conclusions:

• Patients with pectus excavatum undergoing cardiac surgery should be evaluated for concomitant or staged pectus repair.
• For staged procedures, placement of a barrier membrane before chest closure is recommended.
• Pectus repair in cardiac surgery patients is safe and effective when performed by experienced teams.