Simultaneous open-heart surgery and pectus deformity correction

Abstract

Purpose. Pectus deformities and cardiac problems sometimes require simultaneous surgery. We report our experience of performing this surgery and review the relevant literature. Methods. We performed simultaneous pectus deformity correction and open-heart surgery in six patients between 1999 and 2006. The pectus deformities were pectus carinatum in one patient and pectus excavatum in fi ve patients. The cardiac problems were coronary artery disease in one patient, an atrioseptal defect (ASD) with a ventricular septal defect (VSD) in one, a VSD in one, mitral valve insuffi ciency with left atrial dilatation in one, and an ascending aortic aneurysm with aortic valve insuffi ciency caused by Marfan's syndrome in two. We corrected the pectus deformities using the modifi ed Ravitch's sternoplasty in all patients. First, while the patient was supine, we resected the costal cartilage; then, after completing the cardiac surgery, the sternum was closed and the additional time required for the pectus operation was calculated for each patient. Patients were examined 1, 4, and 6 months postoperatively. Results. The average operation time was 102 min, and there were no major complications. The pectus bars were removed 4-6 months postoperatively. Good cardiac and cosmetic results were achieved in all patients, who were followed up for 5 years. Conclusions. Concomitant pectus deformity correctionand open-heart surgery can be performed safely, eliminating the risks of a second operation in a staged procedure.

Simultaneous Aortic Valve Replacement and Pectus Excavatum Correction in a 76-Year-Old Man

“…[3][4][5] Staged operations were formerly recommended; 3) however, single-stage operations have been reported with favorable results in recent years. [4][5][6][7] We decided to perform simultaneous AVR and PE correction using the modified Ravitch procedure 6) to avoid any postoperative cardiopulmonary complications that may result from mechanical compression due to uncorrected sternal deformities. The patient was substantially relieved of his complaint; however, the single-stage operation using the modified Ravitch procedure induced excessive bleeding and a high-volume transfusion secondary to the prolonged operation time and postoperative recovery.…”

“…Okay, et al 4) reported that a single-stage operation using the modified Ravitch procedure was performed without major complications such as excessive bleeding; the average total volume of blood loss in two patients who underwent Bentall's operation was 1095 ml, although the average cardiac operation time was 250 min. In contrast, in our case, the total volume of blood loss was 3990 ml, regardless of the shorter CPB duration of 171 min.…”

“…In these cases, staged operations were formerly recommended; 3) however, single-stage operations have been reported with favorable results in recent years. [4][5][6][7] In this case report, we present an adult patient who successfully underwent simultaneous aortic valve replacement (AVR) and PE correction using the modified Ravitch procedure and discuss surgical management for PE in adult patients.…”

Simultaneous repair of cardiac pathology and severe pectus excavatum in Marfan patients using a modified minimally invasive repair

“…Repair of both the PE and cardiac disease in a single stage is preferable to avoid postoperative difficulties that may result from cardiac compression or displacement into the left thoracic cavity. [4][5][6] Historically, modifications of the open Ravitch-type procedure have been used exclusively for simultaneous repair of the PE and cardiac disease due to the complex nature and greater severity of deformities in adult patients with Marfan syndrome. 4,6,7 Since its introduction by Nuss et al, 8 clinical results have shown the Minimally Invasive Repair PE (MIRPE) to be safe and successful in the Marfan syndrome patient.…”

“…[4][5][6] Historically, modifications of the open Ravitch-type procedure have been used exclusively for simultaneous repair of the PE and cardiac disease due to the complex nature and greater severity of deformities in adult patients with Marfan syndrome. 4,6,7 Since its introduction by Nuss et al, 8 clinical results have shown the Minimally Invasive Repair PE (MIRPE) to be safe and successful in the Marfan syndrome patient. [8][9][10] We describe simultaneous cardiac surgery and chest wall repair in two Marfan adults using a modified MIRPE.…”