Left anterolateral emergency thoracotomy during the Nuss procedure: Lifesaving shortcut

Ghionzoli, Marco; Deaconu, Diana; Ugolini, Sara; Piccolo, Roberto Lo; Messineo, Antonio

doi:10.1111/ped.13033

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…A heart injury may occur when inserting the introducer or the Nuss-bar into the thoracic cavity, or when repositioning a dislocated bar. We identified 27 intraoperative cardiac perforations or lacerations [11,13,[25][26][27][28][29][30][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Nine patients had a history of cardiac surgery.…”

Section: Procedural Heart Injury (N=27)mentioning

confidence: 99%

Life-threatening cardiovascular adverse events related to pectus excavatum surgery

Wolf¹,

Loobuyck²,

Brian³

et al. 2019

Cardiovasc Disord Med

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Background:The occurrence of life-threatening cardiovascular adverse events related to pectus repair is underestimated.Methods: Literature review of severe adverse events affecting the heart, pericardium and large vessels of open or minimally invasive repair. Results:In patients undergoing Willital-Hegemann repair, we identified one death caused by intraoperative cardiac arrest. In patients undergoing Ravitch-type repair, we identified 11 non-lethal life-threatening cardiovascular adverse events: two per/postoperative cardiac injuries and six delayed intracardiac bar migrations (overall, six successful cardiac procedures under CPB were performed); and three intrapericardial migrations of broken sternal wire and consecutive tamponade treated by wire removal and pericardial drainage. Finally, we identified one aortic injury caused by a broken sternal wire 28 years after sternal turnover.In patients undergoing minimally invasive repair we identified 27 cardiac injuries during procedure and three later Nuss-bar removal; one intracardiac migration of the Nuss-bar (overall, four patients died and 11 underwent cardiac procedures under CPB); three procedural vena cava injuries (one patient died); six obstructions of the inferior vena cava (n=3) or right ventricular outflow tract (n=3); three episodes of major bleeding from the ascending aorta (one patient died); two pericardiectomies and three late-onset cardiac tamponades. Eight patients sustained procedural or late-onset cardiac arrest (five patients died). Overall, we identified 56 life-threatening cardiovascular adverse events requiring 12 cardiac/aortic procedures under CPB. There were 11 deaths and two cases of severe hypoxic brain injury. Conclusions:During pectus surgery, the cardiovascular morbidity/mortality related to minimally invasive repair appears more severe, in comparison to open repair.

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