Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum

Awais Ashfaq, Staci Beamer, Mennat Allah M. Ewais, Jesse Lackey, Dawn Jaroszewski

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Minimally invasive repair of pectus excavatum (MIRPE) has been extended to repair of defects in adults, with reported higher complication rates and outcome failures. The optimal revision for a prior failed MIRPE in an adult has not been identified. We review our experience for this adult population. Methods: A retrospective review was performed of 129 patients (age ≥18 years) who underwent revision after a failed pectus excavatum (PE) repair from December 2010 through December 2016. Results: In total, 47 of the 129 (36%) revision patients had a prior failed MIRPE, with 98% presenting for revision because of inadequate correction after their initial repair. The median age was 28 years (range, 18 to 54 years), and 77% were men. Thirty-one (66%) patients had indwelling pectus support bars at the revision procedure. Mean time from initial MIRPE to the revision procedure was 3.34 ± 2.9 years. A modified MIRPE was successful in 39 (83%) patients. Hybrid repair with the addition of osteotomy cuts and/or titanium plating was required in 8 patients for an adequate revision. Multiple (2 bars, 62%; 3 bars, 38%), shorter (median, 13.5 inches versus 15.0 inches) bars were used for the revision versus earlier repair. Substantial lysis of intrathoracic adhesions was required in 40 (85%) patients, with a median operative time for revision MIRPE of 169 ± 66 minutes; median operative time for hybrid procedures, 314 ± 74 minutes. Conclusions: A modified MIRPE can be successfully used in most adults to revise a failed prior MIRPE.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2017

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Funnel Chest
Operative Time
Osteotomy
Titanium

ASJC Scopus subject areas

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

Cite this

Ashfaq, A., Beamer, S., Ewais, M. A. M., Lackey, J., & Jaroszewski, D. (Accepted/In press). Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.08.051

Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum. / Ashfaq, Awais; Beamer, Staci; Ewais, Mennat Allah M.; Lackey, Jesse; Jaroszewski, Dawn.

In: Annals of Thoracic Surgery, 01.01.2017.

Research output: Contribution to journalArticle

Ashfaq, Awais ; Beamer, Staci ; Ewais, Mennat Allah M. ; Lackey, Jesse ; Jaroszewski, Dawn. / Revision of Failed Prior Nuss in Adult Patients With Pectus Excavatum. In: Annals of Thoracic Surgery. 2017.
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abstract = "Background: Minimally invasive repair of pectus excavatum (MIRPE) has been extended to repair of defects in adults, with reported higher complication rates and outcome failures. The optimal revision for a prior failed MIRPE in an adult has not been identified. We review our experience for this adult population. Methods: A retrospective review was performed of 129 patients (age ≥18 years) who underwent revision after a failed pectus excavatum (PE) repair from December 2010 through December 2016. Results: In total, 47 of the 129 (36{\%}) revision patients had a prior failed MIRPE, with 98{\%} presenting for revision because of inadequate correction after their initial repair. The median age was 28 years (range, 18 to 54 years), and 77{\%} were men. Thirty-one (66{\%}) patients had indwelling pectus support bars at the revision procedure. Mean time from initial MIRPE to the revision procedure was 3.34 ± 2.9 years. A modified MIRPE was successful in 39 (83{\%}) patients. Hybrid repair with the addition of osteotomy cuts and/or titanium plating was required in 8 patients for an adequate revision. Multiple (2 bars, 62{\%}; 3 bars, 38{\%}), shorter (median, 13.5 inches versus 15.0 inches) bars were used for the revision versus earlier repair. Substantial lysis of intrathoracic adhesions was required in 40 (85{\%}) patients, with a median operative time for revision MIRPE of 169 ± 66 minutes; median operative time for hybrid procedures, 314 ± 74 minutes. Conclusions: A modified MIRPE can be successfully used in most adults to revise a failed prior MIRPE.",
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