Lessons Learned From Lethal Cardiac Injury by Nuss Repair of Pectus Excavatum in a 16-Year-Old

Schaarschmidt, K.; Lempe, Michael; Schlesinger, F. G.; Jaeschke, U.; Park, Weon; Polleichtner, Susanne

doi:10.1016/j.athoracsur.2012.09.038

Cited by 36 publications

(18 citation statements)

References 8 publications

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“…[24] Occasional case reports have been published about death after Nuss procedure due to right atrial and ventricular laceration, or cardiac tamponade. [25][26][27] Recent advances in surgical techniques may help prevent complications and lead to fewer events occurring in peri-and postoperative period of Nuss procedure.…”

Section: Discussionmentioning

confidence: 99%

Internal Thoracic Artery Patency Before and After Insertion of Specially Designed Pectus Bar

Ermerak¹,

Bektaşoğlu²,

Çimşit³

et al. 2017

South Clin Ist Euras

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Objective: Blood flow in internal thoracic arteries (ITAs) may become blocked in patients who have had minimally invasive repair of pectus excavatum (MIRPEx). Aim of this study was to investigate patency of ITAs in patients who underwent MIRPEx with pectus bars that were specially designed to protect ITAs. Methods:Total of 22 patients over the age of 16 years who were to undergo correction of pectus excavatum (PEx) were included in this study. Patients with previous surgical intervention for PEx were excluded. Computed tomography-angiography (CTA) of the thorax was performed preoperatively on all patients to evaluate ITA blood flow. MIRPEx procedure included use of specially designed bars in all cases. On postoperative 10 th day, follow-up CTA of the thorax was performed. Pre-and postoperative CTAs were compared to determine any effect of bars on ITAs.Results: Study group comprised 19 male patients and 3 female patients; mean age was 18.81±2.48 years (range: 16-23 years). Blood flow was not affected in 18 patients (88.8%) and was unilaterally blocked in 4 patients (18.2%) after the operation. Conclusion:Results demonstrate that only 1 in 5 patients had unilateral ITA occlusion following MIRPEx with uniquely designed bar.

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Section: Discussionmentioning

confidence: 99%

Internal Thoracic Artery Patency Before and After Insertion of Specially Designed Pectus Bar

Ermerak¹,

Bektaşoğlu²,

Çimşit³

et al. 2017

South Clin Ist Euras

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“…Although serious life-threatening complications after the Nuss procedure are rare [15], [16], [17], VATS used during the operation may further reduce the perioperative risk. The available evidence in the literature was mostly reported from large institutions in developed countries, and no publications on the surgical outcomes and safety in the application of VATS for the Nuss procedure were known in resourcescare conditions such as Vietnam.…”

Section: Read Full License Introductionmentioning

confidence: 99%

365 Patients with Pectus Excavatum Undergoing Video-Assisted Thoracoscopic Surgery for the Nuss Procedure: A 5-Year Single-Institution Experience

Uoc¹,

Lu²,

Sơn³

et al. 2020

Preprint

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Objective: We conducted this study to review our large single-center experience in Vietnam in the use of the VATS-NUSS for 365 consecutive patients with PE within the five years and to evaluate mid-term to long-term outcome in these patients. Methods: In this retrospective study, we consecutively selected the patients with the diagnosis of PE who underwent VATS-NUSS from January 2015 to September 2019. A total of 365 patients who were surgically treated for PE at the Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital (Hanoi, Vietnam) was included in final analysis. Results: The length of postoperative hospitalization ranged from 1 to 13 days (Mean: 5.1). Early postoperative complications were recorded up to 30 days during hospital stay, consisting of pneumothorax (n = 5, 1.37%), pleural bleeding / pleural fluid (n = 2, 0.55%), pleural hematoma (n = 1, 0.27%), pneumonia (n = 1, 0.27%), surgical wound infection (n = 1, 0.27%), incision fluid accumulation (n = 3, 0.82%), metal bar infection (n = 1, 0.27%), atelectasis (n = 3, 0.82%), and fever (n = 8, 2.19%). In the late postoperative complications, surgical wound infection (n = 2, 0.55%), metal bar deviation (n = 5, 1.37%), metal bar allergy (n = 10, 2.74%), recurrent PE (n = 2, 0.55%), and persistent PE (n = 5, 1.37%) were observed. No deaths occurred. The outcomes related to the bar removal that was carried out in 175 patients (47.95%). The time the bar was in situ ranged from 2 to 49 months (mean: 28.89±7.48 years). The mean operative time at bar removal was 34.09 ± 10.61 minutes, and the length of hospitalization following bar removal was 2.4 ± 1.34 days. Of 175 patients performed bar removal, the most frequent complication was pneumothorax, which was diagnosed in 19 (10.85%) patients; surgical wound infection in 1 patient and incision fluid accumulation in 1 patient were observed following bar removal. Towards mid-term results at 6 – 30 months postoperatively, there were 124 out of 365 patients (33.97%). Of 124 patients, most patients were unremoved the bar (n = 121, 97.58%), and only 3 patients were removed the bar (2.42%). Most patients had body weight gain (n = 97, 78.23%), and increased physical activity and improved health (n = 115, 92.74%). The Haller index on chest X-ray was 2.44 ± 0.15. 220 out of 365 patients (60.27%) were postoperatively evaluated long-term results at over 30 months. Of those, 172 received bar removal (78.18%) and 48 have not yet received bar removal (21.82%). 217 patients (98.64%) had both body weight gain, and increased physical activity and improved health. The Haller index on chest X-ray was 2.45±0.21. Conclusions: The VATS-NUSS for PE was safe and effective approach with minimizing the occurrence of serious intra- and postoperative complications. From our initial one-institution experience in a resource-scare country, good mid-term to long-term postoperative outcomes in PE patients were obtained with VATS-NUSS. Current rare evidence drawn from this cohort enables to give a real picture in the application, modification and development of VATS-NUSS not only for Vietnam but also the countries having similar resource-scare conditions.

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“…The main advantage demonstrated with this approach is avoiding invasion of the mediastinum and the pleural cavity in order to reduce the main complications of MIRPE and the risk of injury to vital organs (4,5). The aim of this technique is to offer another therapeutic option within the surgical arsenal, and in particular to patients who are fearful of being operated on by other procedures.…”

Section: Advantagesmentioning

confidence: 99%

Taulinoplasty: the traction technique—a new extrathoracic repair for pectus excavatum

Bardají¹,

Cassou²

2016

Ann. Cardiothorac. Surg.

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Lessons Learned From Lethal Cardiac Injury by Nuss Repair of Pectus Excavatum in a 16-Year-Old

Cited by 36 publications

References 8 publications

Internal Thoracic Artery Patency Before and After Insertion of Specially Designed Pectus Bar

Internal Thoracic Artery Patency Before and After Insertion of Specially Designed Pectus Bar

365 Patients with Pectus Excavatum Undergoing Video-Assisted Thoracoscopic Surgery for the Nuss Procedure: A 5-Year Single-Institution Experience

Taulinoplasty: the traction technique—a new extrathoracic repair for pectus excavatum

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