Cardiac surgery and repair of pectus deformities: When and how?

Abstract

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.

Aortic surgery in Marfan patients with severe pectus excavatum

“…Long term results (mean follow-up time of 52 AE 45 months, range 8-119) have been reported in two studies. 25,26 No deaths occurred after aortic surgery in Marfan patients with severe pectus excavatum.…”

“…Six of the 27 articles were case series. 4,13,15,23,26,27 The majority of the reports were from East Asia, with 23 articles 7,9,14,16,20,21,24 (Supplementary File, http://links.lww.com/JCM/A84).…”

“…Alternate approaches can be challenging whenever aortic root surgery is required. 29 Case series of corrections of chest wall deformities and acquired 13,15,23,26,27 or congenital 13 Aortic root dilatation is found in 80% of Marfan syndrome patients, 30 and up to 66% of Marfan patients present with pectus excavatum. 31 Connective-tissue-disorder-related genes, such as FBN, collagen and TGF linked to Marfan syndrome are also involved in the genesis of pectus excavatum, 31 which is characterized by overgrowth of lower diseased costal cartilage that pushes the sternal body inward and in most cases can closely approach the vertebral body.…”

“…Published peer-reviewed letters to the editor 16,25 (Supplementary File, http:// links.lww.com/JCM/A84) were not excluded from the review process. To avoid duplications, only the most recent study on the topic by the same authors was included in the analysis 15,26 (Supplementary File, http://links.lww.com/JCM/A84).…”

Reply

“…This omission is critical, especially as Zhang and colleagues [3] reported elsewhere a death in an 11-year-old boy following right atrial injury during similar subxyphoid approach. Altogether, these cases associated with three previous reports of procedural heart injury during the Nuss procedure or later Nuss-bar removal after a history of cardiac surgery cast doubt on the safety of this technique [4]. Second, spontaneous improvement of pectus excavatum occurs in 40% of patients between 1 and 13 years of age, and current orthopedic treatment (vacuum bell) can be efficient in this population [4].…”