Dawn E Jaroszewski1, Paul J Gustin1, Frank-Martin Haecker2, Hans Pilegaard3, Hyung Joo Park4, Shao-Tao Tang5, Shuai Li5, Li Yang5, Sadashige Uemura6, Jose Ribas Milanez De Campos7, Robert Obermeyer8, Frazier W Frantz8, Michele Torre9, Lisa McMahon1,10, Andre Hebra11, Chih-Chun Chu12, J Duncan Phillips13, David M Notrica1,10, Antonio Messineo14, Robert Kelly8, Mustafa Yüksel15. 1. Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. 2. Department of Pediatric Surgery, University Children's Hospital, University of Basel, Basel, Switzerland. 3. Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark. 4. Department of Cardiothoracic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 5. Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 6. Department of Pediatric Surgery, Kawasaki Medical School, Kurashiki, Japan. 7. Department of Thoracic Surgery, Hospital das Clinicas, Sao Paulo, Brazil. 8. Department of Pediatric Surgery, Children's Hospital of the King's Daughters, Norfolk, VA, USA. 9. Airway Team Unit, Department of Pediatric Surgery, Istituto G. Gaslini, Genoa, Italy. 10. Department of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA. 11. Department of Surgery, Nemours Children's Hospital, Orlando, FL, USA. 12. Department of Surgery, Country Hospital, Taipei, Taiwan. 13. Department of Pediatric Surgery, WakeMed Health and Hospitals, Raleigh, NC, USA. 14. Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy. 15. Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey.
Abstract
OBJECTIVES: Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population. METHODS: Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed. RESULTS: Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality. CONCLUSIONS: Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres.
OBJECTIVES:Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population. METHODS: Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed. RESULTS: Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality. CONCLUSIONS: Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres.