912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon's experience.

BACKGROUND: Severe pectus excavatum (PE) is common, often causing physiologic impairment. Inconsistent results have been reported using a variety of open surgical techniques with extensive subperiosteal costal cartilage resection.
METHODS: Since 1969, 912 (80% men) symptomatic PE patients (mean severity index 4.9) underwent open surgical correction at UCLA Medical Center by one surgeon. Almost all patients had dyspnea, reduced endurance, tachypnea, and tachycardia with exertion. The mean age at operation was 19.8 years. Asymmetric depression was present in 465 (51%) patients; combined PE and pectus carinatum was present in 33 patients. Recurrent PE deformities were repaired on 73 patients. Progressively less deformed costal cartilage was resected during the 38-year period; almost all of the last 303 patients had only short segments excised from both ends with suture reattachment. Transverse wedge sternal osteotomy was used on all patients, and 883 (97%) had a sternal support strut for 6 to 9 months.
RESULTS: Dyspnea, endurance, tachypnea, and tachycardia was improved in almost all patients within 5 months after repair. Repair for recurrent deformities and resection of mild localized cartilage protrusion was reduced more than threefold when minimal cartilage resection with wire reattachment was used. Postoperative complications in the last 537 patients were less frequent, pain was less severe, and results were better than when more extensive previous repairs were used (mean follow-up 7.6 years). Very good or excellent results were reported by 94.2% of all patients.
CONCLUSIONS: In this largest series of open PE repair, progressively less extensive operative techniques have resulted in low morbidity, mild pain, short hospitalization, and very good physiologic and cosmetic results.