Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars

Dawn E Jaroszewski, Paul J Gustin, Frank-Martin Haecker, Hans Pilegaard, Hyung Joo Park, Shao-Tao Tang, Shuai Li, Li Yang, Sadashige Uemura, Jose Ribas Milanez De Campos, Robert Obermeyer, Frazier W Frantz, Michele Torre, Lisa McMahon, Andre Hebra, Chih-Chun Chu, J Duncan Phillips, David M Notrica, Antonio Messineo, Robert KellyMustafa Yüksel

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)710-717
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number4
DOIs
Publication statusPublished - Oct 1 2017

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Funnel Chest
Sternotomy
Thoracic Wall
Thoracic Surgery
Wounds and Injuries
Thoracoscopy
Cardiopulmonary Bypass

Keywords

  • Journal Article

Cite this

Jaroszewski, D. E., Gustin, P. J., Haecker, F-M., Pilegaard, H., Park, H. J., Tang, S-T., ... Yüksel, M. (2017). Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars. European Journal of Cardio-thoracic Surgery, 52(4), 710-717. https://doi.org/10.1093/ejcts/ezx221

Pectus excavatum repair after sternotomy : the Chest Wall International Group experience with substernal Nuss bars. / Jaroszewski, Dawn E; Gustin, Paul J; Haecker, Frank-Martin; Pilegaard, Hans; Park, Hyung Joo; Tang, Shao-Tao; Li, Shuai; Yang, Li; Uemura, Sadashige; De Campos, Jose Ribas Milanez; Obermeyer, Robert; Frantz, Frazier W; Torre, Michele; McMahon, Lisa; Hebra, Andre; Chu, Chih-Chun; Phillips, J Duncan; Notrica, David M; Messineo, Antonio; Kelly, Robert; Yüksel, Mustafa.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 4, 01.10.2017, p. 710-717.

Research output: Contribution to journalArticle

Jaroszewski, DE, Gustin, PJ, Haecker, F-M, Pilegaard, H, Park, HJ, Tang, S-T, Li, S, Yang, L, Uemura, S, De Campos, JRM, Obermeyer, R, Frantz, FW, Torre, M, McMahon, L, Hebra, A, Chu, C-C, Phillips, JD, Notrica, DM, Messineo, A, Kelly, R & Yüksel, M 2017, 'Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars', European Journal of Cardio-thoracic Surgery, vol. 52, no. 4, pp. 710-717. https://doi.org/10.1093/ejcts/ezx221
Jaroszewski, Dawn E ; Gustin, Paul J ; Haecker, Frank-Martin ; Pilegaard, Hans ; Park, Hyung Joo ; Tang, Shao-Tao ; Li, Shuai ; Yang, Li ; Uemura, Sadashige ; De Campos, Jose Ribas Milanez ; Obermeyer, Robert ; Frantz, Frazier W ; Torre, Michele ; McMahon, Lisa ; Hebra, Andre ; Chu, Chih-Chun ; Phillips, J Duncan ; Notrica, David M ; Messineo, Antonio ; Kelly, Robert ; Yüksel, Mustafa. / Pectus excavatum repair after sternotomy : the Chest Wall International Group experience with substernal Nuss bars. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 52, No. 4. pp. 710-717.
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T1 - Pectus excavatum repair after sternotomy

T2 - the Chest Wall International Group experience with substernal Nuss bars

AU - Jaroszewski, Dawn E

AU - Gustin, Paul J

AU - Haecker, Frank-Martin

AU - Pilegaard, Hans

AU - Park, Hyung Joo

AU - Tang, Shao-Tao

AU - Li, Shuai

AU - Yang, Li

AU - Uemura, Sadashige

AU - De Campos, Jose Ribas Milanez

AU - Obermeyer, Robert

AU - Frantz, Frazier W

AU - Torre, Michele

AU - McMahon, Lisa

AU - Hebra, Andre

AU - Chu, Chih-Chun

AU - Phillips, J Duncan

AU - Notrica, David M

AU - Messineo, Antonio

AU - Kelly, Robert

AU - Yüksel, Mustafa

PY - 2017/10/1

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N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1093/ejcts/ezx221

DO - 10.1093/ejcts/ezx221

M3 - Article

C2 - 29156016

VL - 52

SP - 710

EP - 717

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 4

ER -