Ilir Hysi1, André Vincentelli2, Francis Juthier2, Lotfi Benhamed3, Carlo Banfi2, Natacha Rousse2, Jean-Marc Frapier4, Fabien Doguet5, Alain Prat2, Alain Wurtz2. 1. Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France. Electronic address: ilirhysi@gmail.com. 2. Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France. 3. Department of Thoracic Surgery, Valenciennes Hospital, Valenciennes, France. 4. Department of Cardiac Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France. 5. Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France.
Abstract
OBJECTIVES: There is currently a lack of recommendations about patients with pectus deformities requiring cardiac surgery. This study reports the results of our surgical strategy on this issue. METHODS: Eleven patients, from three centers treated over a 9-year period were included in this study. Pectus deformities were operated with a modified Ravitch procedure. In the case of pectus excavatum repair and concomitant cardiac surgery, subperichondrial resection of abnormal rib cartilages was always performed before the sternotomy and an easily removable retrosternal metallic strut was inserted at the end of the procedure ensuring anterior chest wall stability. During follow-up patients had to estimate their current appearance with a numeric scale ranging from 0 to 100. RESULTS: Mean age was 27 ± 9.4 years. Pectus excavatum was present in 8 patients and pectus arcuatum in 3. There were 6 Marfan syndrome patients. Nine patients had concomitant surgery and, 2 underwent pectus repair after a history of cardiac surgery. There was no operative mortality. In the case of concomitant surgery, heart exposure through median sternotomy was facilitated by abnormal rib cartilage resection. Median follow-up was 54 months (range 16.7-119.7). Mean cosmetic result evaluated by the patients was 97.3 (±2.5). CONCLUSIONS: In adults, concomitant scheduled surgery is reliable and offers excellent long-term cosmetic results. Moreover, it allows a better thoracic exposition with no added perioperative risk. The modified Ravitch technique seems more adequate in these patients as it can be used in all types of pectus deformities.
OBJECTIVES: There is currently a lack of recommendations about patients with pectus deformities requiring cardiac surgery. This study reports the results of our surgical strategy on this issue. METHODS: Eleven patients, from three centers treated over a 9-year period were included in this study. Pectus deformities were operated with a modified Ravitch procedure. In the case of pectus excavatum repair and concomitant cardiac surgery, subperichondrial resection of abnormal rib cartilages was always performed before the sternotomy and an easily removable retrosternal metallic strut was inserted at the end of the procedure ensuring anterior chest wall stability. During follow-up patients had to estimate their current appearance with a numeric scale ranging from 0 to 100. RESULTS: Mean age was 27 ± 9.4 years. Pectus excavatum was present in 8 patients and pectus arcuatum in 3. There were 6 Marfan syndromepatients. Nine patients had concomitant surgery and, 2 underwent pectus repair after a history of cardiac surgery. There was no operative mortality. In the case of concomitant surgery, heart exposure through median sternotomy was facilitated by abnormal rib cartilage resection. Median follow-up was 54 months (range 16.7-119.7). Mean cosmetic result evaluated by the patients was 97.3 (±2.5). CONCLUSIONS: In adults, concomitant scheduled surgery is reliable and offers excellent long-term cosmetic results. Moreover, it allows a better thoracic exposition with no added perioperative risk. The modified Ravitch technique seems more adequate in these patients as it can be used in all types of pectus deformities.
Authors: Lily Pollock; Ashley Ridout; James Teh; Colin Nnadi; Dionisios Stavroulias; Alex Pitcher; Edward Blair; Paul Wordsworth; Tonia L Vincent Journal: Curr Rheumatol Rep Date: 2021-11-26 Impact factor: 4.592