Original article
General thoracic
Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years)

https://doi.org/10.1016/j.athoracsur.2016.03.105Get rights and content

Background

Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial.

Methods

We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older.

Results

Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74).

Conclusions

The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.

Section snippets

Material and Methods

The Mayo Clinic Institutional Review Board approved this retrospective study, which included adult patients (18 years of age and older) who underwent PE repair from January 1, 2010, to April 30, 2015, with follow-up through December 31, 2015. Electronic medical records of 361 patients were reviewed to obtain data from the preoperative evaluation, hospital course, and follow-up period. Only cases of primary repair were analyzed because of the complexity and heterogeneous nature of revisions.

Results

During the study period, 361 adult patients (≥18 years of age) underwent PE repair; 207 (57.3%) were at least 30 years of age. Of the total, 95 patients who had revisions were excluded from analysis (18 to 29 years of age: 39; ≥30 years of age: 56). Therefore, 266 patients with primary repairs were entered in the study (18 to 29 years of age: 115 [43.2%]; ≥30 years of age: 151 [56.8%]). Demographic characteristics of the 2 groups (18 to 29 years of age and ≥30 years of age) are compared in

Comment

As patients grow older, their PE symptoms may worsen 2, 4, 7, 23. Kragten and colleagues [4] noted nearly half of their older patients’ symptoms developed in their 30s to 40s. Decreased chest wall flexibility may be one reason for this symptom progression. When PE is corrected, symptoms may be substantially reduced or resolved 4, 6, 7, 8, 23. Correlations between physiologic impact and symptoms in adults on CPET and by echocardiographic findings have been reported 3, 5, 6, 24, 25, 26. Neviere

References (40)

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