The questionable benefit of pectus excavatum repair on cardiopulmonary function: a prospective study

Abstract

OBJECTIVES Since the introduction of the minimally invasive technique for repair of pectus excavatum (MIRPE), increasing numbers of patients are presenting for surgery. However, controversy remains regarding cardiopulmonary outcomes of surgical repair. Therefore, the aim of our prospective study was to investigate cardiopulmonary function, at rest and during exercise before surgery, first after MIRPE and then after pectus bar removal. METHODS Forty-seven patients were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) [NCT02163265] between July 2013 and November 2019. All patients underwent a modified MIRPE technique for surgical correction of pectus excavatum (PE), called Minor Open Videoendoscopically Assisted Repair of Pectus Excavatum. The patients underwent pre- and postoperative chest X-ray, three-dimensional volume-rendering computer tomography thorax imaging, cardiopulmonary function tests at rest and during stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography. Daily physical activity questionnaires were also completed. RESULTS The study was completed by 19 patients (15 males, 4 females), aged 13.9–19.6 years at the time of surgery. The surgical patient follow-up was 5.7 ± 7.9 months after pectus bar removal. No significant differences in cardiopulmonary and exercise parameters were seen after placement of the intrathoracic bar, or after pectus bar removal, compared to presurgery. CONCLUSIONS Our findings indicate that surgical correction of PE does not impair cardiopulmonary function at rest or during exercise. Therefore, no adverse effects on exercise performance should be expected from surgical treatment of PE via the modified MIRPE technique. Clinical trial registration number clinicaltrials.gov [ClinicalTrials.gov number, NCT02163265].

Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK

“…Seven of the 11 studies showed overall improvement in CPET variables after surgery with mean increased of VO 2max ranging from 6% to 40% and mean improvements in in oxygen pulse of 10%–44% 10 12–14 18 27 28. Four studies found CPET variables to be unchanged after surgery 15 17 20 25. Six of the studies demonstrated improvements in VO 2max and eight showed improvements in O 2 pulse.…”

“…Sixteen studies have investigated exercise testing after surgical repair of PEx 14–27. The primary outcome measures reported were maximal oxygen consumption (VO 2max ), VO 2max per kilogram and oxygen pulse, which is a surrogate for stroke volume.…”

“…Resting pulmonary function has been extensively studied as measure of physiological improvement postsurgical repair, with mixed results. Of the 21 studies to measure PFTs, 15 have been in children10–14 17 20 21 23 25 29–34 and 6 in adults 19 22 24 35–37. Six studies investigated patients undergoing Ravitch repair, all of which showed no change in PFTs after surgery 14 22 33–36…”

Simultaneous pectus excavatum repair using sternal plate in a patient undergoing the Bentall procedure

“…Typically, sternum is depressed to the vertebral column at the xiphoid process level. Patients with pectus excavatum deformity are most often asymptomatic, but may encounter respiratory problems when depression is significant, and this circumstance reduces the capacity of the chest cavity and causes pressure on the heart (4). Different surgical techniques are described in the treatment of pectus excavatum.…”

Malformaciones de la caja torácica: pectus excavatum

“…The questionable benefit of Pectus Excavatum repair on cardiopulmonary function: a prospective study. (Del Frari et al, 2021) 19 pacientes con Pectus Excavatum…”