Pectus excavatum repair after sternotomy:the Chest Wall International Group experience with substernal Nuss bars
| Autor: | Hans K. Pilegaard, Li Yang, Dawn E. Jaroszewski, Andre Hebra, Frazier W. Frantz, Mustafa Yüksel, José Ribas Milanez de Campos, J.Duncan Phillips, Michele Torre, Sadashige Uemura, Chih-Chun Chu, Lisa E. McMahon, Hyung Joo Park, Shuai Li, Antonio Messineo, Frank-Martin Haecker, Robert J. Obermeyer, Shao-tao Tang, Robert E. Kelly, David M. Notrica, Paul J Gustin |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Sternum medicine.medical_specialty Heart Diseases medicine.medical_treatment 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Pectus excavatum Interquartile range law Thoracoscopy Cardiopulmonary bypass Journal Article Humans Medicine Thoracoplasty Cardiac Surgical Procedures Child Thoracic Wall Retrospective Studies medicine.diagnostic_test business.industry Prostheses and Implants General Medicine medicine.disease Sternotomy Cardiac surgery Surgery Treatment Outcome 030228 respiratory system Median sternotomy Funnel Chest Female Haller index Cardiology and Cardiovascular Medicine business |
| Zdroj: | Jaroszewski, D E, Gustin, P J, Haecker, F-M, Pilegaard, H, Park, H J, Tang, S-T, Li, S, Yang, L, Uemura, S, De Campos, J R M, Obermeyer, R, Frantz, F W, Torre, M, McMahon, L, Hebra, A, Chu, C-C, Phillips, J D, Notrica, D M, Messineo, A, Kelly, R & Yüksel, M 2017, ' Pectus excavatum repair after sternotomy : the Chest Wall International Group experience with substernal Nuss bars ', European Journal of Cardio-Thoracic Surgery, vol. 52, no. 4, pp. 710-717 . https://doi.org/10.1093/ejcts/ezx221 |
| Popis: | OBJECTIVES: Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population.METHODS: Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed.RESULTS: Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality.CONCLUSIONS: Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres. |
| Databáze: | OpenAIRE |
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