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Prognostic Factors for Pectus Carinatum Treated by Dynamic Compression System: PECTUSDYN Trial
Lorraine Kieffer De Marco1, Laura Filaire2, Sophie Vermersch1
1Department of Pediatric Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
Insights
Dynamic compression bracing (DCB) effectively treats pectus carinatum (PC). Initial correction pressure (PIC) is a key factor predicting pectus height reduction with DCB treatment.
Area of Science:
- Thoracic surgery
- Orthopedics
- Pediatric surgery
Background:
- Pectus carinatum (PC) is a chest wall deformity.
- Dynamic compression bracing (DCB) offers a non-surgical treatment option for PC.
- Identifying prognostic factors can optimize DCB treatment outcomes.
Purpose of the Study:
- To identify prognostic factors for successful pectus height reduction using DCB.
- To evaluate the effectiveness of DCB in treating pectus carinatum.
- To analyze the relationship between initial correction pressure and treatment outcomes.
Main Methods:
- Retrospective review of 297 patients treated with DCB for PC (2011-2020).
- Primary outcome: ≤50% reduction in pectus height (PH) at 6 months, measured by radiation-free imaging.
- Statistical models adjusted for treatment compliance were employed.
Main Results:
- A mean PH reduction of -35.8% was observed at 6 months in 114 patients with available data.
- 53.5% of patients achieved ≥50% PH reduction.
- Higher initial correction pressure (PIC ≥ 7.5 psi) was significantly associated with greater PH reduction (OR=2.53, P=.024).
Conclusions:
- Initial correction pressure (PIC) is a significant prognostic factor for pectus height reduction with DCB.
- These findings require validation in ongoing prospective studies.
- DCB demonstrates effectiveness in non-surgical PC correction.
Objectives:
Dynamic compression bracing (DCB) systems have been proven safe and effective for non-surgical treatment of pectus carinatum (PC). This study aimed to identify potential prognostic factors for correcting PC using DCB.
Methods:
From 2011 to 2020, all patients treated with DCB for PC at the University Hospital of Saint-Etienne were reviewed retrospectively. The primary outcome was a ≤50% reduction in pectus height (PH) at the 6-month follow-up, measured by radiation-free imaging. Two statistical models adjusted for compliance with treatment were used.
Results:
A total of 297 patients were treated with DCB (mean age: 15.4 ± 3.9 years). A total of 42% of deformities were symmetrical. Baseline mean PH and pressure for initial correction (PIC) were 2.97 ± 1.02 cm and 6.5 ± 2.0 psi, respectively. The median total treatment duration was 13.1 months (9.2-17.9). Among the 114 (46.5%) patients with available PH data, the median decrease in PH was -35.8% (-62.4% to -10.0%) after 6 months of DCB, with 61 patients (53.5%) achieving a reduction ≥ 50% in PH. In multivariate analysis, only PIC (odds ratio = 1.34; 95% confidence interval, 1.09-1.64; P = .005) was significantly associated with PH reduction in model 1, and PIC ≥ 7.5 psi (odds ratio = 2.53; 95% confidence interval, 1.13-5.67; P = .024) in model 2. Patient compliance was 85.2% at 6 months. The recurrence rate was 11.3% (n = 26).
Conclusions:
The PIC value appears to be a potential prognostic factor for PH reduction after 6 months of treatment with DCB. These results will be validated in an ongoing prospective study.
Clinical Trial:
The study was approved by the ethical committee "Terres d'Ethique" (IRBN902020/CHUSTE) and registered at Clinicaltrials.gov (NCT04452721).
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