Hybrid technique for repair of recurrent pectus excavatum after failed open repair

Kevin N. Johnson, Dawn E. Jaroszewski, Mennatallah Ewais, Jesse J. Lackey, Lisa McMahon, David M. Notrica

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Successful repair of recurrent pectus excavatum (PE) after failed open procedure has been reported using minimally invasive repair (MIRPE) and open approaches. Neither approach alone may be adequate for some patients. A hybrid technique for repair is presented for revision of recurrent PE. Methods A retrospective review of adults undergoing repair for recurrent PE after prior open repair from January 2010 to June 2014 was performed. Results Seventy-three adult patients underwent repair for recurrent PE, with 48 patients (65.8%) undergoing repair for recurrence after at least one prior open PE repair. Mean patient age was 34.5 years (range, 19 to 54 years); mean Haller index was 4.7 (range, 2.8 to 14.7). Fourteen (29%) recurrences with adequate chest wall pliability and no malunion were repaired with MIRPE alone; 34 patients (71%) underwent a hybrid procedure for repair (20 for PE recurrence alone; 14 for PE with acquired thoracic dystrophy). All had at least two support bars placed, and 11 patients (23%) had three bars placed. Mean hospitalization for MIRPE was 5 days, for hybrid was 7 days, and for hybrid because of acquired thoracic dystrophy was 10 days. One patient died of unexpected out-of-hospital arrest; there was one emergent conversion to open sternotomy for bleeding. Conclusions Most recurrent PE may be repaired with excellent results and minimal complications. Those with adequate chest pliability and no malunion are candidates for MIPRE alone. A hybrid procedure with thoracoscopic support bars combined with sternal elevation, multiple open osteotomies, and chest wall fixation is appropriate for recurrences associated with malunion or fixation of the anterior chest and failure to lift with MIRPE.

Original languageEnglish (US)
Pages (from-to)1936-1943
Number of pages8
JournalAnnals of Thoracic Surgery
Volume99
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Funnel Chest
Thorax
Recurrence
Thoracic Wall
Pliability
Sternotomy
Osteotomy
Hospitalization
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Johnson, K. N., Jaroszewski, D. E., Ewais, M., Lackey, J. J., McMahon, L., & Notrica, D. M. (2015). Hybrid technique for repair of recurrent pectus excavatum after failed open repair. Annals of Thoracic Surgery, 99(6), 1936-1943. https://doi.org/10.1016/j.athoracsur.2015.02.078

Hybrid technique for repair of recurrent pectus excavatum after failed open repair. / Johnson, Kevin N.; Jaroszewski, Dawn E.; Ewais, Mennatallah; Lackey, Jesse J.; McMahon, Lisa; Notrica, David M.

In: Annals of Thoracic Surgery, Vol. 99, No. 6, 01.06.2015, p. 1936-1943.

Research output: Contribution to journalArticle

Johnson, KN, Jaroszewski, DE, Ewais, M, Lackey, JJ, McMahon, L & Notrica, DM 2015, 'Hybrid technique for repair of recurrent pectus excavatum after failed open repair', Annals of Thoracic Surgery, vol. 99, no. 6, pp. 1936-1943. https://doi.org/10.1016/j.athoracsur.2015.02.078
Johnson, Kevin N. ; Jaroszewski, Dawn E. ; Ewais, Mennatallah ; Lackey, Jesse J. ; McMahon, Lisa ; Notrica, David M. / Hybrid technique for repair of recurrent pectus excavatum after failed open repair. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 6. pp. 1936-1943.
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abstract = "Background Successful repair of recurrent pectus excavatum (PE) after failed open procedure has been reported using minimally invasive repair (MIRPE) and open approaches. Neither approach alone may be adequate for some patients. A hybrid technique for repair is presented for revision of recurrent PE. Methods A retrospective review of adults undergoing repair for recurrent PE after prior open repair from January 2010 to June 2014 was performed. Results Seventy-three adult patients underwent repair for recurrent PE, with 48 patients (65.8{\%}) undergoing repair for recurrence after at least one prior open PE repair. Mean patient age was 34.5 years (range, 19 to 54 years); mean Haller index was 4.7 (range, 2.8 to 14.7). Fourteen (29{\%}) recurrences with adequate chest wall pliability and no malunion were repaired with MIRPE alone; 34 patients (71{\%}) underwent a hybrid procedure for repair (20 for PE recurrence alone; 14 for PE with acquired thoracic dystrophy). All had at least two support bars placed, and 11 patients (23{\%}) had three bars placed. Mean hospitalization for MIRPE was 5 days, for hybrid was 7 days, and for hybrid because of acquired thoracic dystrophy was 10 days. One patient died of unexpected out-of-hospital arrest; there was one emergent conversion to open sternotomy for bleeding. Conclusions Most recurrent PE may be repaired with excellent results and minimal complications. Those with adequate chest pliability and no malunion are candidates for MIPRE alone. A hybrid procedure with thoracoscopic support bars combined with sternal elevation, multiple open osteotomies, and chest wall fixation is appropriate for recurrences associated with malunion or fixation of the anterior chest and failure to lift with MIRPE.",
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N2 - Background Successful repair of recurrent pectus excavatum (PE) after failed open procedure has been reported using minimally invasive repair (MIRPE) and open approaches. Neither approach alone may be adequate for some patients. A hybrid technique for repair is presented for revision of recurrent PE. Methods A retrospective review of adults undergoing repair for recurrent PE after prior open repair from January 2010 to June 2014 was performed. Results Seventy-three adult patients underwent repair for recurrent PE, with 48 patients (65.8%) undergoing repair for recurrence after at least one prior open PE repair. Mean patient age was 34.5 years (range, 19 to 54 years); mean Haller index was 4.7 (range, 2.8 to 14.7). Fourteen (29%) recurrences with adequate chest wall pliability and no malunion were repaired with MIRPE alone; 34 patients (71%) underwent a hybrid procedure for repair (20 for PE recurrence alone; 14 for PE with acquired thoracic dystrophy). All had at least two support bars placed, and 11 patients (23%) had three bars placed. Mean hospitalization for MIRPE was 5 days, for hybrid was 7 days, and for hybrid because of acquired thoracic dystrophy was 10 days. One patient died of unexpected out-of-hospital arrest; there was one emergent conversion to open sternotomy for bleeding. Conclusions Most recurrent PE may be repaired with excellent results and minimal complications. Those with adequate chest pliability and no malunion are candidates for MIPRE alone. A hybrid procedure with thoracoscopic support bars combined with sternal elevation, multiple open osteotomies, and chest wall fixation is appropriate for recurrences associated with malunion or fixation of the anterior chest and failure to lift with MIRPE.

AB - Background Successful repair of recurrent pectus excavatum (PE) after failed open procedure has been reported using minimally invasive repair (MIRPE) and open approaches. Neither approach alone may be adequate for some patients. A hybrid technique for repair is presented for revision of recurrent PE. Methods A retrospective review of adults undergoing repair for recurrent PE after prior open repair from January 2010 to June 2014 was performed. Results Seventy-three adult patients underwent repair for recurrent PE, with 48 patients (65.8%) undergoing repair for recurrence after at least one prior open PE repair. Mean patient age was 34.5 years (range, 19 to 54 years); mean Haller index was 4.7 (range, 2.8 to 14.7). Fourteen (29%) recurrences with adequate chest wall pliability and no malunion were repaired with MIRPE alone; 34 patients (71%) underwent a hybrid procedure for repair (20 for PE recurrence alone; 14 for PE with acquired thoracic dystrophy). All had at least two support bars placed, and 11 patients (23%) had three bars placed. Mean hospitalization for MIRPE was 5 days, for hybrid was 7 days, and for hybrid because of acquired thoracic dystrophy was 10 days. One patient died of unexpected out-of-hospital arrest; there was one emergent conversion to open sternotomy for bleeding. Conclusions Most recurrent PE may be repaired with excellent results and minimal complications. Those with adequate chest pliability and no malunion are candidates for MIPRE alone. A hybrid procedure with thoracoscopic support bars combined with sternal elevation, multiple open osteotomies, and chest wall fixation is appropriate for recurrences associated with malunion or fixation of the anterior chest and failure to lift with MIRPE.

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