Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature

Abstract

Patients with pectus excavatum (PE) often describe improvements in exercise stamina following corrective surgery. Studies have investigated the surgical effect on physiological parameters; still, no consensus has yet been reached. Therefore, the aim of this literature review was to describe the cardiac outcome after surgical correction, both at rest and during exercise. In February 2016, a detailed search of the databases PubMed, Medline, and EMBASE was performed. We assessed clinical studies that described cardiac outcomes both before and after surgical correction of PE. We only included studies reporting either pre-defined echocardiographic or exercise test parameters. No exclusion criteria or statistical analyses were applied.Twenty-one full-text articles, published between 1972 and 2016, were selected, with cohort-ranges of 3-168 patients, mean age-ranges of 5-33 years, and mean follow-up-ranges from immediately to 4 years after surgery. Twelve studies described resting cardiac parameters. Four studies measured cardiac output, where one described 36% immediate increase after surgery, one reported 15% increase after Nuss-bar removal and two found no difference. Three studies demonstrated improvement in mean stroke volume ranges of 22-34% and two studies found no difference. Fifteen studies investigated exercise capacity, with 11 considering peak O 2 pr. kg, where five studies demonstrated improvements with the mean ranging from 8% to 15% after surgery, five studies demonstrated no difference, and one saw a decrease of 19% 3 months after Nuss-bar implantation. A measurable increase in exercise capacity exists following surgery, which may be caused by multiple factors. This may be owed to the relief of compressed cardiac chambers with the increased anteriorposterior thoracic dimensions, which could facilitate an improved filling of the heart. With these results, the positive physiological impact of the surgery is emphasized and the potential gain in cardiac function should be integrated in the clinical assessment of patients with PE.

Pectus excavatum from a pediatric surgeon’s perspective

“…Secondly, with the large influx of patients, it was now possible to study cardiopulmonary function. Numerous studies have been performed since, demonstrating that there is significant cardiopulmonary dysfunction pre-operatively and significant improvement post-operatively (16)(17)(18). Research performed at The Children's Hospital of the Kings Daughters (CHKD) demonstrated a possible explanation for improved respiratory mechanics after pectus excavatum repair, using motion analysis (19).…”

Improvement of cardiopulmonary function after minimally invasive surgical repair of pectus excavatum (Nuss procedure) in children

“…The improvement of maximum oxygen consumption in our study after surgical repair appears to be due to increase in stroke volume during exercise, and our results are similar to other published studies. [22]…”

Changes in chest wall motion with removal of Nuss bar in repaired pectus excavatum – a cohort study

“…Improvement in exercise capacity is reported after insertion of a Nuss bar to repair PE; this has been shown to be related to improved ventricular filling as the heart is relieved of compression by the displaced sternum [8–10]. The impact of PE upon respiratory mechanics is more controversial with inconsistent results of both static lung function and non invasive assessment of chest wall motion [4, 11].…”