Revision after prior failed pectus excavatum repair: higher risks and greater complications than primary surgery.

Autor:	Shawwaf KA; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Aly MR; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Botros MM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Moosavi RS; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Zeineddine RM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Lackey JJ; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Sandstrom B; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Farina JM; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA., Jaroszewski DE; Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Jul 30; Vol. 16 (7), pp. 4359-4378. Date of Electronic Publication: 2024 Jul 18.
DOI:	10.21037/jtd-24-417
Abstrakt:	Background: Revision of a prior failed pectus excavatum (PE) repair is occasionally required. These procedures may be technically more complex and have a greater risk of complications. This study was performed to evaluate the outcomes of adult patients undergoing revision procedures. Methods: A retrospective review of adult patients who underwent revision of a prior PE repair from 2010 to 2023 at Mayo Clinic Arizona was performed. Patients were classified by prior procedure [minimally invasive repair of pectus excavatum (MIRPE), Open/Ravitch, and both] and the type of revision procedure performed [MIRPE, hybrid MIRPE, complex hybrid reconstruction, or complex reconstruction of acquired thoracic dystrophy (ATD)]. Outcomes and complications of these groups were analyzed and compared. Results: In total, 190 revision cases were included (mean age was 33±10 years; 72.6% males, mean Haller Index: 4.4±1.8). For the initial repair procedure, 90 (47.4%) patients had a previous MIRPE, 87 (45.8%) patients a prior open repair, and thirteen (6.8%) patients had both. Furthermore, 30 (15.8%) patients had two or more prior interventions. Patients having had a prior MIRPE were able to be repaired with a revision MIRPE in 82.2% of the cases. Conversely, patients with a prior open repair (including those who had both prior MIRPE and open repairs) were much more likely to require complex reconstructions (85%) as none of the ATD patients in this group had an attempted MIRPE. Operative times were shortest in the MIRPE redo approach and longest in the complex reconstruction of the ATD patients (MIRPE 3.5±1.3 hours, ATD 6.9±1.8 hours; P<0.001). The median length of hospital stay was 5 days [interquartile range (IQR), 3.0 days] with the shortest being the MIRPE approach and the longest occurring in the complex reconstruction of the ATD patients [MIRPE 4 days (IQR, 3.0 days); ATD 7 days (IQR, 4.0 days); P<0.001]. Major and minor complications were more frequent in the ATD complex reconstruction group. Preoperative chronic pain was present in over half of the patients (52.6%). Although resolution was seen in a significant number of patients, significant pain issues persisted in 8.8% of the patients postoperatively. Overall, persistent, long term chronic pain was greatest in the post open/Ravitch patient group (open 13.6% vs. MIRPE 3.6%, P=0.02). Conclusions: Revision of a prior failed PE repair can be technically complex with a high risk of complications, prolonged duration of surgery, and lengthy hospitalization. Chronic pain is prevalent and its failure to completely resolve after surgery is not uncommon. The initial failed repair will influence the type of procedure that can be performed and potentially subsequent complications. Even when some recurrences after previous PE surgeries can be repaired with acceptable results, this study demonstrates the importance of proper primary repair due to these increased risks. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-417/coif). D.E.J. serves as an unpaid editorial board member of Journal of Thoracic Disease from February 2023 to January 2025. D.E.J. is a consultant with IP/royalty rights under Mayo Clinic Ventures with Zimmer Biomet, Inc. The other authors have no conflicts of interest to declare. (2024 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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