Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years)

Dawn E. Jaroszewski, Mennat Allah M Ewais, Chieh Ju Chao, Michael Gotway, Jesse J. Lackey, Kelly M. Myers, Marianne V. Merritt, Stephanie M. Sims, Lisa E. McMahon, David M. Notrica

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial. Methods: We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older. Results: Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74). Conclusions: The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016

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Funnel Chest
Osteotomy
Young Adult
Electronic Health Records
Transesophageal Echocardiography
Operative Time
Reoperation
Demography
Pediatrics

ASJC Scopus subject areas

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

Cite this

Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years). / Jaroszewski, Dawn E.; Ewais, Mennat Allah M; Chao, Chieh Ju; Gotway, Michael; Lackey, Jesse J.; Myers, Kelly M.; Merritt, Marianne V.; Sims, Stephanie M.; McMahon, Lisa E.; Notrica, David M.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

Jaroszewski, Dawn E. ; Ewais, Mennat Allah M ; Chao, Chieh Ju ; Gotway, Michael ; Lackey, Jesse J. ; Myers, Kelly M. ; Merritt, Marianne V. ; Sims, Stephanie M. ; McMahon, Lisa E. ; Notrica, David M. / Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years). In: Annals of Thoracic Surgery. 2016.
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abstract = "Background: Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial. Methods: We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older. Results: Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5{\%} men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7{\%} of patients older than 30 years of age versus 96.5{\%} of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2{\%} after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74). Conclusions: The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.",
author = "Jaroszewski, {Dawn E.} and Ewais, {Mennat Allah M} and Chao, {Chieh Ju} and Michael Gotway and Lackey, {Jesse J.} and Myers, {Kelly M.} and Merritt, {Marianne V.} and Sims, {Stephanie M.} and McMahon, {Lisa E.} and Notrica, {David M.}",
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T1 - Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years)

AU - Jaroszewski, Dawn E.

AU - Ewais, Mennat Allah M

AU - Chao, Chieh Ju

AU - Gotway, Michael

AU - Lackey, Jesse J.

AU - Myers, Kelly M.

AU - Merritt, Marianne V.

AU - Sims, Stephanie M.

AU - McMahon, Lisa E.

AU - Notrica, David M.

PY - 2016

Y1 - 2016

N2 - Background: Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial. Methods: We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older. Results: Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74). Conclusions: The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.

AB - Background: Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial. Methods: We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older. Results: Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74). Conclusions: The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.

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