Improved Dynamics of Thoracic Cage and Exercise Capacity after Nuss Repair for Pectus Excavatum

Yeh, S. C.; Yang, Mei‐Chen; Chang, Yu-Hsun; Hsu, Yu-Ting; Tzeng, I‐Shiang; Cheng, Yeung-Leung

doi:10.1055/s-0039-1683384

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…The Nuss procedure uses steel plate(s) under the depressed thoracic wall with the aid of a thoracoscope. The popularity of this procedure has increased rapidly [3, 8, 9]. The procedure provides support to the depressed thoracic wall, thereby reducing the compression on cardiopulmonary organs.…”

Section: Introductionmentioning

confidence: 99%

Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

Yang

Cui

et al. 2019

World j. surg.

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Background Patients with pectus excavatum have a poorer subjective sleep quality and quality of life than the general population. The Nuss procedure has been shown to improve these patients' quality of life, but data regarding their postoperative sleep quality are lacking. We aimed to evaluate the objective sleep quality of adults with pectus excavatum before and after the Nuss procedure. Methods Twenty-eight participants completed this study. Epworth Sleepiness Scale (ESS) scores for daytime sleepiness, Pittsburgh Sleep Quality Index (PSQI) scores for subjective sleep quality, and overnight polysomnography for objective sleep quality were evaluated before and 6 months after the Nuss procedure.Results Subjective sleep quality improved after the Nuss procedure. The median PSQI score decreased from 7 [interquartile range (IQR): 5; 9] to 5 (IQR: 4; 7, p = 0.029); the median percentage of poor PSQI sleep quality decreased from 64.3 to 35.7% (p = 0.048). The median percentage of rapid eye movement sleep significantly increased after surgery [15.6% (IQR: 12.2%; 19.8%) vs. 20.4% (IQR: 14.5%; 24.9%), p = 0.016]. Sleep interruptions also improved, with the median arousal index decreasing from 9.5 (IQR: 4.8; 18.2) to 8.2 (IQR: 4.3; 12.1; p = 0.045). However, there was no significant change in ESS scores after surgery (p = 0.955). Conclusions Pectus excavatum may be associated with poor subjective and objective sleep quality in adults, and the condition may improve after the Nuss procedure. For adults with pectus excavatum who report poor subjective sleep quality, polysomnography should be considered to assess their preoperative and postoperative sleep condition. Characteristics Cases (n = 28) Age, years (IQR) 24.0 (22.0; 27.5) Gender Male, n (%) 25 (89.3%) Female, n (%) 3 (10.7%) Body height, cm (IQR) 173 (167; 177.8) Body weight, kg (IQR) 62.5 (55.0; 65.8) Body mass index, kg/m 2 (IQR) 20.2 (18.9; 21.9) Haller index (IQR) 3.6 (3.3; 4.3) Pulmonary function rest FVC, % of predicted value (IQR) 80.0 (69.5; 91.3) FEV1, % of predicted value (IQR) 83.5 (73.5; 91.3) FEV1/FVC, % (IQR) 87.5 (83.3; 91.0) TLC, % of predicted value (IQR) 88.5 (84.0; 96.0) Restrictive lung defect, n (%) 2 (7.1%) Continuous data (age, body height, body weight, body mass index, Haller index) are shown as the median and interquartile range, and categorical data (gender) are shown as a count (%) IQR interquartile range, FVC forced vital capacity, FEV1 forced expiratory volume in 1 s, TLC total lung capacity

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Section: Introductionmentioning

confidence: 99%

Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

Yang

Cui

et al. 2019

World j. surg.

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“…In our previous study, postoperative changes in chest wall shapes mostly occurred within 1 month, and the chest wall diameter stabilized 3 months after the Nuss repair. (15) All cases in our present study were followed up for at least 6 months, which was an adequate time period for monitoring PE recurrence. A correlation between bar ipping and PE recurrence can be explained as follows: The convex bars strut the depressed sternum, and the tendency of the anterior chest wall to rebound inwards causes bar ipping even before the chest wall can be remodeled.…”

Section: Discussionmentioning

confidence: 98%

A Retrospective Study on the Impact of Bar Flipping on the Recurrence of Pectus Excavatum after the Nuss Procedure

Fan

Hsu

et al. 2021

Preprint

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BackgroundThe Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping.MethodsThis retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI×100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests.ResultsIn this study, 359 adult and adolescent patients with an average age of 23.9±7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n=131), α = 11-20° (n=154), α = 21-30° (n=51), and α > 30° (n=23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p<0.001).ConclusionsThe α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

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“…In our previous study, postoperative changes in chest wall shapes mostly occurred within one month, and the chest wall diameter stabilized three months after the Nuss repair [ 18 ]. All cases in our present study were followed up for at least six months, which was an adequate time period for monitoring PE recurrence.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

Fan

Hsu

et al. 2021

J Cardiothorac Surg

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Background The Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping. Methods This retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI × 100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests. Results In this study, 359 adult and adolescent patients with an average age of 23.9 ± 7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n = 131), α = 11–20° (n = 154), α = 21–30° (n = 51), and α > 30° (n = 23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p < 0.001). Conclusions The α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

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Improved Dynamics of Thoracic Cage and Exercise Capacity after Nuss Repair for Pectus Excavatum

Cited by 6 publications

References 27 publications

Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

A Retrospective Study on the Impact of Bar Flipping on the Recurrence of Pectus Excavatum after the Nuss Procedure

A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

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