32. A Twenty-five Year Review of Pectus Deformity Repairs Including Simultaneous Intracardiac Repair

Charles Willekes, Carl L. Backer, Constantine Mavroudis

Children’s Memorial Hospital Northwestern University Medical School

Chicago, Ill.
 

Objective: Review our operative and long-term results with repair of pectus excavatum and pectus carinatum deformities through a vertical mid-line approach, including those with simultaneous intracardiac repair.

Methods: One hundred fifteen children underwent pectus deformity repair between 1972 and 1997. Operative technique utilized a vertical mid-line incision with subperichondrial resection of deformed cartilages and sternal osteotomy. Thirty patients had a temporary metal bar for retrosternal support for six months, 85 were repaired without a bar. Patients and parents were asked to assess the outcome from pectus repair as poor, fair good, or excellent.

Results: There were 90 males and 25 females. Age ranged from 2-21 years (mean 8.4 years). There were 106 cases of pectus excavatum and nine cases of pectus carinaturm. Twelve children (10 percent) had an associated congenital heart defect. Seven patients had simultaneous pectus and intracardiac repair. There were no mortality and only one significant complication, a return to the operating room for bleeding. Morbidity was not higher in those with simultaneous intracardiac repair. Long-term follow-up was established in 83 percent of patients. Results were classified as excellent, 59 (62 percent); good, 25 (26 percent), fair (8 percent); and poor (3 percent). Of 30 patients with a sternal bar, 25 (83 percent) had excellent results versus 34 of 65 (52 percent) without a bar (p=0.004).

Conclusions: Long-term results of pectus excavatum and carinatum repair through a vertical mid-line approach are excellent. Outcome with a temporary sternal bar is superior to outcome without a bar. Concomitant repair of congenital heart defects and pectus deformity may be performed successfully without additional morbidity.