Double-Lung Transplant With Delayed Nuss Bar Prostheses for Pectus Excavatum Deformity

Severe pectus excavatum and prior talc pleurodesis are traditionally considered relative contraindications to lung transplantation. A 36-year-old woman with idiopathic pulmonary fibrosis, pectus excavatum with a Haller Index of 6.7, and prior bilateral talc pleurodesis underwent successful bilateral lung transplantation. Chest closure was delayed due to right heart compression. On postoperative day 6, staged chest wall reconstruction with 2 Nuss bars was performed. She recovered without complications, was discharged on day 70, and remains off oxygen 910 days after transplant. With multidisciplinary planning and staged reconstruction, lung transplantation is feasible in select patients with complex chest wall pathology.