Late coronary artery and tricuspid valve injury post pectus excavatum surgery

Lage, Ignacio Bibiloni; Khan, Khalid; Kaabneh, Ahmed; Kendall, Simon

doi:10.1093/icvts/ivt280

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…A failed STRATOS implant also brings the danger of loose and migrating long pieces of metal with sharp ends in the cardiothoracic region (Fig 2a, b) with its vital blood carrying vessels and organs like heart and lung. A recent study reported migration of a pectus bar through the tricuspid valve into the right atrium of the heart, damaging the right coronary artery and posterior leaflet of the tricuspid valve on the way [10].…”

Section: Commentmentioning

confidence: 99%

Implant Failure: STRATOS System for Pectus Repair

Sharma

Willems

Touw

et al. 2017

The Annals of Thoracic Surgery

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Combined tensile, compressive, bending, and torsional loading on the implant during each breathing cycle caused loosening and fatigue fractures, which led to failure. Excessive rubbing at the fracture and loosening site caused the release of large amounts of titanium in the surrounding tissue, which may lead to metallosis. Long and sharp pieces of failed implant in the cardiothoracic region is a grave danger to vital organs. All patients should be closely followed, and in our opinion, all implants should be removed. Serious reconsideration for clinical use of this implant is necessary.

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Section: Commentmentioning

confidence: 99%

Implant Failure: STRATOS System for Pectus Repair

Sharma

Willems

Touw

et al. 2017

The Annals of Thoracic Surgery

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“…Cardiopulmonary ByPass patients sustained intracardiac bar migration from two to 37 years after the initial procedure as a consequence of failure to remove the bar in a timely manner and/or broken material[17][18][19][20]. Injured cardiac structures are detailed in Table1.…”

mentioning

confidence: 99%

Life-threatening cardiovascular adverse events related to pectus excavatum surgery

Wolf¹,

Loobuyck²,

Brian³

et al. 2019

Cardiovasc Disord Med

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Background:The occurrence of life-threatening cardiovascular adverse events related to pectus repair is underestimated.Methods: Literature review of severe adverse events affecting the heart, pericardium and large vessels of open or minimally invasive repair. Results:In patients undergoing Willital-Hegemann repair, we identified one death caused by intraoperative cardiac arrest. In patients undergoing Ravitch-type repair, we identified 11 non-lethal life-threatening cardiovascular adverse events: two per/postoperative cardiac injuries and six delayed intracardiac bar migrations (overall, six successful cardiac procedures under CPB were performed); and three intrapericardial migrations of broken sternal wire and consecutive tamponade treated by wire removal and pericardial drainage. Finally, we identified one aortic injury caused by a broken sternal wire 28 years after sternal turnover.In patients undergoing minimally invasive repair we identified 27 cardiac injuries during procedure and three later Nuss-bar removal; one intracardiac migration of the Nuss-bar (overall, four patients died and 11 underwent cardiac procedures under CPB); three procedural vena cava injuries (one patient died); six obstructions of the inferior vena cava (n=3) or right ventricular outflow tract (n=3); three episodes of major bleeding from the ascending aorta (one patient died); two pericardiectomies and three late-onset cardiac tamponades. Eight patients sustained procedural or late-onset cardiac arrest (five patients died). Overall, we identified 56 life-threatening cardiovascular adverse events requiring 12 cardiac/aortic procedures under CPB. There were 11 deaths and two cases of severe hypoxic brain injury. Conclusions:During pectus surgery, the cardiovascular morbidity/mortality related to minimally invasive repair appears more severe, in comparison to open repair.

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Post‐operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

Roostaei,

Amini,

Abtahi

et al. 2024

Clinical Case Reports

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Key Clinical MessageCommon complications after PE surgery include ventricular tachycardia, cardiac arrest, pneumothorax, and bar displacement. These can lead to severe outcomes, emphasizing the need for caution and meticulous post‐operative monitoring. Patients and their families should be well‐informed about potential risks during the consent process.AbstractThe objective of this study was to raise awareness among medical staff and surgeons about potential complications, particularly rare and life‐threatening ones, associated with pectus excavatum (PE) surgery. PE is the most common chest wall deformity, characterized by sternal depression. Patients primarily seek treatment for cosmetic concerns, but some also report exercise intolerance and shortness of breath. Although surgical repair is the standard treatment, the incidence and nature of severe complications remain unclear and underreported. This study presents a case of a lethal cardiac event following PE surgery and conducts a systematic review of published case reports. This study describes a case of a lethal complication of ventricular fibrillation and cardiac arrest following the Ravitch procedure for correction of PE in a 10‐year‐old boy. A systematic review of relevant cases of PE surgery complications was conducted. Of the 506 initial records retrieved, 93 case reports from 83 articles were identified over the 23 years. Among them, 72 patients were male, and 20 cases were female. The average age of patients was 19.2 ± 7.7 years (range: 5–53). Complications had occurred up to 37 years from the time of surgery, with most of the cases (22.5%) occurring during the operation. The most frequent complications included cardiothoracic issues and displacement of the implanted steel bar. In nine patients, complications led to fatal outcomes. Due to the possible risks of PE surgery, particularly in cosmetically motivated cases, surgeons must exercise extreme caution and remain vigilant for rare and potentially life‐threatening complications.

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Late coronary artery and tricuspid valve injury post pectus excavatum surgery

Cited by 5 publications

References 4 publications

Implant Failure: STRATOS System for Pectus Repair

Implant Failure: STRATOS System for Pectus Repair

Life-threatening cardiovascular adverse events related to pectus excavatum surgery

Post‐operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

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