Abstract

 

OBJECTIVES

Pectus excavatum (PE) can be secondary in patients who underwent sternotomy for cardiac surgery. Retrosternal adhesions increase the complexity and risk of traditional Nuss repair. Thus, we summarized the outcomes of our modified Nuss procedure using a newly designed bar.

METHODS

A retrospective analysis was performed on 35 patients who underwent modified PE repair after open heart surgery from January 2011 to July 2019. The surgery was performed using a novel bar with no need for intraoperative reshaping and rotation, assisted by thoracoscopy and subxiphoid incision when necessary.

RESULTS

There were 19 males and 16 females with a median age of 5.3 years (interquartile range, 4.1–10.9) at PE repair. All patients underwent the modified procedure uneventfully with no death. The median operating time was 70 min. Twenty-nine (82.9%) patients required subxiphoid incision assistance. There was 1 case (2.8%) with unexpected sternotomy due to intraoperative bleeding. The median length of postoperative hospital stay was 4 days. During the median 3.5 years of follow-up, no bar dislocation was found and 30 (85.7%) patients had their bars removed with no recurrence recorded. After PE repair, the Haller index improved significantly (2.6 ± 0.4 vs 4.9 ± 1.3, P < 0.05) and further decreased till the time of bar removal (2.5 ± 0.4 vs 2.6 ± 0.4, P < 0.05). All patients were satisfied with the cosmetic outcome.

CONCLUSIONS

The novel bar can be placed and removed easily with a low rate of adverse events. This modified Nuss procedure seems to be a safe, effective and convenient approach for the management of PE after cardiac surgery.

中文翻译：

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先天性心脏病术后漏斗胸患者采用新型钢筋改良 Nuss 手术

摘要

 

目标

漏斗胸 (PE) 可继发于接受胸骨切开术进行心脏手术的患者。胸骨后粘连增加了传统 Nuss 修复的复杂性和风险。因此，我们使用新设计的条形图总结了修改后的 Nuss 程序的结果。

方法

回顾性分析了2011年1月至2019年7月接受心脏直视手术后改良PE修复的35例患者。手术采用新型杆进行，无需术中重塑和旋转，必要时辅助胸腔镜和剑突下切口。

结果

PE 修复时男性 19 例，女性 16 例，中位年龄为 5.3 岁（四分位距，4.1-10.9）。所有患者均顺利接受了改良手术，没有死亡。中位手术时间为 70 分钟。29 名 (82.9%) 患者需要剑突下切口辅助。1例（2.8%）因术中出血意外胸骨切开。术后住院时间中位数为 4 天。在中位 3.5 年的随访期间，没有发现杆脱位，30 名（85.7%）患者的杆被移除，没有记录复发。PE 修复后，Haller 指数显着改善（2.6 ± 0.4 vs 4.9 ± 1.3，P  < 0.05）并进一步下降，直到去除钢筋时（2.5 ± 0.4 vs 2.6 ± 0.4，P < 0.05)。所有患者都对美容效果感到满意。

结论

新型棒可以轻松放置和移除，不良事件发生率低。这种改良的 Nuss 手术似乎是一种安全、有效和方便的心脏手术后 PE 管理方法。