Pectus excavatum repair after sternotomy: The Chest Wall International Group experience with substernal Nuss bars

Dawn E. Jaroszewski, Paul J. Gustin, Frank Martin Haecker, Hans Pilegaard, Hyung Joo Park, Shao Tao Tang, Shuai Li, Li Yang, Sadashige Uemura, Jose Ribas Milanez De Campos, Robert Obermeyer, Frazier W. Frantz, Michele Torre, Lisa McMahona, Andre Hebra, Chih Chun Chu, J. Duncan Phillips, David M. Notrica, Antonio Messineo, Robert KellyMustafa Yüksel

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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 substernal 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 preemptively 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.

Original languageEnglish (US)
Pages (from-to)710-717
Number of pages8
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number4
StatePublished - Oct 1 2017


  • Complications
  • Minimally invasive surgery
  • Nuss
  • Pectus excavatum
  • Revision surgery
  • Sternotomy

ASJC Scopus subject areas

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


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