Does a high Haller index influence outcomes in pectus excavatum repair?

Autor:	Zeineddine RM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Botros M; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Shawwaf KA; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Moosavi R; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Aly MR; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Farina JM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Lackey JJ; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Sandstrom BA; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz., Jaroszewski DE; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Ariz. Electronic address: jaroszewski.dawn@mayo.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Nov; Vol. 168 (5), pp. 1395-1402. Date of Electronic Publication: 2024 Apr 10.
DOI:	10.1016/j.jtcvs.2024.04.005
Abstrakt:	Objective: Severity for pectus excavatum includes Haller index (HI) > 3.25. An extremely high HI (≥8) may influence surgical approach and complications. This study reviews outcomes of patients with high HI after repair. Methods: A single institution retrospective analysis was performed on adult patients with HI ≥ 8 undergoing pectus excavatum repairs. For outcomes, a propensity score-matched control group with a HI ≤ 4 was utilized. Results: In total, 64 cases (mean age, 33.5 ± 10.9 years; HI, 13.1 ± 5.0; 56% women) were included. A minimally invasive repair was successful in 84%. A hybrid procedure was performed in the remaining either to repair fractures of the ribs (8 patients) and sternum (5 patients) or when osteotomy and/or cartilage resection was required (10 patients). In comparison with the matched cohort (HI ≤ 4), patients with high HI had longer operative times (171 vs 133 minutes; P < .001), more frequently required hybrid procedures (16% vs 2%; P = .005), experienced higher incidences of rib (22% vs 3%; P = .001) and sternal fractures (12% vs 0%; P = .003), and had increased repair with 3 bars (50% vs 19%; P < .001). There were no significant differences between the groups for length of hospital stay or postoperative 30-day complications. Conclusions: Patients with an extremely high HI can be challenging cases with greater risks of fracture and need for osteotomy/cartilage resection. Despite this, minimally invasive repair techniques can be utilized in most cases without increased complications when performed by an experienced surgeon. Competing Interests: Conflict of Interest Statement Dr Jaroszewski discloses consulting and IP/royalties through Mayo Clinic Ventures with Zimmer Biomet Inc. All other authors reported no conflict of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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