Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum

Abstract

A modified MIRPE can be successfully used in most adults to revise a failed prior MIRPE.

Minimally Invasive Pectus Excavatum Repair (MIRPE)

“…4,6,[50][51][52][53][54] In our adult practice, we have placed 2 or more bars in 99% of patients undergoing primary pectus repair (over 30) and 100% of patients undergoing revision of prior failed MIRPE. 15 A decreased risk of migration and reoperation with multiple bars has also been reported by others. 4,50,51 In one report, reoperation for bar migration or incomplete correction was reported for 15.5% of single-bar repairs versus no reoperations required for patients repaired with 2 bars.…”

“…A unilateral stabilizer was recommended by Nuss et al; 55 however, we discontinued its use in 2008 due to chronic pain issues and a significantly high rate of bar migration. Circumferential fixation of the bar and rib 6,15,48,49,56 with FiberWire is performed as well as medial sternal fixation. 6,12,13,15,18 Sternal fixation is routinely recommended to secure the lower bar and may help prevent rotation.…”

“…The inability for the intercostal muscle and space to support the weight of the bar in larger and older patients is a major cause for failure of MIRPE in this group. 5,6,15,48 (C, D) Stripping of the intercostal muscle and lateral-posterior migration can be easily identified with an A-P chest X-ray showing distal bar tips converging. Imaging with computerized tomography can confirm these findings.…”

Elastic stable chest repair and its hybrid variants in 86 patients with pectus excavatum

“…Impressively, the present study reveals that a bar support can very well stabilize even challenging, complex deformities when combined with direct osteosynthesis procedures, as has been described in the context of revisions to the MIRPE (9). Plates are applied locally to deformed key points of the anterior chest wall toward providing modular correction.…”

“…The closed mobilization of the chest wall by internal pressure in the context of the MIRPE is expediently applied in the growth phase or as long as the chest wall is elastic enough but has a higher complication rate in fully formed adults (8)(9)(10). As elasticity decreases with age and also with the degree of asymmetry of the deformity, open surgical procedures allow more precise mobilization and reduction of the chest wall.…”