Update: Maturation of Care of Pectus Excavatum at the Home of the Nuss Procedure Over the Last Decade
Robert E. Kelly, Jr., Robert J. Obermeyer, M.D., Michael J. Goretsky, M.D., M Ann Kuhn, M.D., Frazier W. Frantz, M.D., Margaret M. McGuire, M.D., Duane S. Duke, M.D., Antarius Daniel, Donald Nuss, M.B., Ch.B.
Children's Hospital of The King's Daughters, Norfolk, VA, USA.
Objective: To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years.Summary Background Data: In 2010, we reported 21 years of the Nuss procedure in 1215 patients.Methods: Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6-46); 996 were primary, and 38 redo operations. Surgical patients' mean CT index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery.
Results: At primary operation, one bar was placed in 49.8%; two bars, 49.4%; and three bars, 0.7%. There were no deaths. Cardiac perforation occurred in one patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7% . A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in three primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases.
Conclusions: A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful.
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