Modified Nuss procedure with a novel steel bar in patients with pectus excavatum post-congenital heart surgery. (18th October 2021)

• Record Type: Journal Article
• Authors: Liu, Siming; Wang, Lei; Zhang, Hongkun; Zeng, Wenhui; Hu, Fengqing; Xiao, Haibo; Li, Guoqing; Mei, Ju; Zhu, Jiaquan
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 3(2022)
• Page Start: 424
• Page End: 430
• Publication Date: 2021-10-18
• Subjects: Pectus excavatum -- Congenital cardiac surgery -- Nuss procedure -- Minimally invasive surgery; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab284
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: Pectus excavatum (PE) can be secondary in patients who underwent sternotomy for cardiac surgery. Retrosternal adhesions increase the complexity and risk of traditional Nuss repair. Thus, we summarized the outcomes of our modified Nuss procedure using a newly designed bar. METHODS: A retrospective analysis was performed on 35 patients who underwent modified PE repair after open heart surgery from January 2011 to July 2019. The surgery was performed using a novel bar with no need for intraoperative reshaping and rotation, assisted by thoracoscopy and subxiphoid incision when necessary. RESULTS: There were 19 males and 16 females with a median age of 5.3 years (interquartile range, 4.1–10.9) at PE repair. All patients underwent the modified procedure uneventfully with no death. The median operating time was 70 min. Twenty-nine (82.9%) patients required subxiphoid incision assistance. There was 1 case (2.8%) with unexpected sternotomy due to intraoperative bleeding. The median length of postoperative hospital stay was 4 days. During the median 3.5 years of follow-up, no bar dislocation was found and 30 (85.7%) patients had their bars removed with no recurrence recorded. After PE repair, the Haller index improved significantly (2.6 ± 0.4 vs 4.9 ± 1.3, P < 0.05) and further decreased till the time of bar removal (2.5 ± 0.4 vs 2.6 ± 0.4, P < 0.05). All patients were satisfied with the cosmetic outcome. CONCLUSIONS: The novel bar can be placed and removed easily with a low rate of adverse events. This modified Nuss procedure seems to be a safe, effective and convenient approach for the management of PE after cardiac surgery. Abstract : Pectus excavatum (PE), as the most common thoracic deformity, can develop after sternotomy for congenital heart disease.