Life-threatening cardiovascular adverse events related to pectus excavatum surgery

Abstract

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.

Cardiopulmonary resuscitation in pediatric pectus excavatum patients—Where is the heart?

“…Second, because computed tomography images were taken before correction surgery and after pectus‐bar removal, the location of the heart in the presence of the pectus bar was not evaluated. Previous studies stressed the impossibility of effective cardiac compression due to the presence of the pectus bar 7,9,15 . Strong chest compression over the high‐resistant pectus bar is currently recommended 15 .…”

“…Patients with pectus excavatum might be at a higher risk of perioperative cardiac arrest than the normal population. Recent articles reviewed the life‐threatening cardiovascular adverse events that occurred during and after correction surgery 3,9 . Of 76 published and unpublished life‐threatening cardiovascular adverse events related to correction surgery, 18 patients (23.7%) died and two (2.6%) suffered a severe hypoxic brain injury.…”

Anaesthesia for the surgical correction of chest wall deformities

“…A study looking solely at severe cardiovascular lifethreatening events related to PE surgery suggests these are more common in minimally invasive techniques than open repair, but the numbers are small and the denominator for each type of surgery is unknown. 15 Major complications such as these rarely require emergency cardiopulmonary bypass. Minor complications include pericardial tears, lung trauma, and pleural and pericardial effusions, which can be managed conservatively.…”

The anesthesiologic management of bar removal after the Nuss procedure for repair of pectus excavatum

“…Відсепарування пластини від тканин, з якими вона зростається, є найбільш травматичним етапом операції. Пластина при видаленні може пошкодити органи середостіння, груднину, ребра [3,8].…”