Nuss procedure for repair of pectus excavatum after failed Ravitch procedure in adults: indications and caveats

Kocher, Gregor J.; Gstrein, Nathalie; Jaroszewski, Dawn E.; Ewais, MennatAllah M.; Schmid, Ralph A.

doi:10.21037/jtd.2016.06.60

Cited by 13 publications

(9 citation statements)

References 13 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the most well‐known is the Ravitch procedure, studies on performing cardiac surgery after the Ravitch procedure are lacking. In the post‐Ravitch cases, the re‐repair of pectus excavatum may be needed at the time of cardiac surgery because unsatisfactory correction may still occur due to osteonecrosis and malunion 15 . We think that it is important to accumulate significant experience in cardiac surgery after repair of pectus excavatum because each surgical repair technique poses a particular challenge.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

et al. 2021

View full text Add to dashboard Cite

We report a case of complete revascularization after a sternal turnover procedure through median sternotomy in a patient with multivessel coronary artery disease. The patient had unusual anatomical features, such as the anterior protrusion of the middle‐to‐distal sternum and absent bilateral internal thoracic arteries (ITAs). The single‐blade sternum retractor and the Omni‐Tract retractors are simple and reliable tools for lifting and widening the thoracic wall around the xiphoid process. The bilateral radial arteries and the great saphenous vein were used as bypass grafts. Computed tomography was used to visualize the sternum supplied by the superior epigastric arteries (SEAs); presurgical abdominal ultrasonography revealed the course and crossing point of the developed SEAs. Since ITAs were absent, we preserved the SEAs to prevent sternal ischemia. No sternal complications or graft occlusion were observed during follow‐up.

show abstract

Section: Discussionmentioning

confidence: 99%

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

et al. 2021

View full text Add to dashboard Cite

show abstract

“…These repairs eventually became well studied in the pediatric population. The Nuss procedure has been shown to have less blood loss and lower operative time, as well as possibly a shorter length Original Article Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures of stay, strong patient satisfaction, lower blood transfusion, and lower overall complication rate (9)(10)(11)(12). Reoperation will be necessary for the Nuss procedure to remove the bar, if the bar migrates, and has been associated with a higher rate of hemopneumothorax (10).…”

Section: Introductionmentioning

confidence: 99%

Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures

Brungardt¹,

Chizek²,

Schropp³

2021

J Thorac Dis

View full text Add to dashboard Cite

Background: National data is limited on pectus excavatum, the most common chest wall deformity which is often repaired using the Ravitch and Nuss procedures. The purpose of the study was to describe demographics and outcomes of adult patients who underwent surgical repair of pectus excavatum via open and minimally invasive thoracoscopic methods. Methods: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2018 was performed, capturing patients 18 years or older with pectus excavatum as the postoperative diagnosis. Patients were placed into two groups of minimally invasive (Nuss) and open (Ravitch) repair procedure code. Baseline characteristics and postoperative outcomes were analyzed. Results: A total of 168 adult patients were captured. Most of these patients were white (84.52%) male (69.64%) and 26 years old on average. Median operative time was longer in the open repair group [250 (IQR, 173-308) versus 122 (IQR, 94-160) minutes, P<0.0001]. Median length of stay was five days (IQR, 4-6) in the open group and three days (IQR, 2-4) in the minimally invasive group (P=0.2873). Conclusions: Complications after repair of pectus excavatum occur at similar rates between open and minimally invasive repair. Though minimally invasive repair decreases operative time and may decrease length of stay, the decision of type of procedure depends upon clinical scenario and factors unique to the individual patient.

show abstract

“…The minimally invasive repair of pectus excavatum without any cartilage resection was primarily developed for children, but it has gained more and more widespread acceptance in adults [ 1 ]. First attempt to correct PE was performed in 1911 by Ludwig Meyer and Ravitch procedure was subsequent reported since 1949 [ 2 , 3 ]. After that, Nuss procedure (NP) and several technical modifications by the placement of metal bars to lift the depressed chest wall was introduced and considered as popular minimally invasive technique to repair PE [ 2 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

Wang

Liu

et al. 2021

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue. Methods Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes. Results All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90 ± 5.75 ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups. Conclusion Through the main clinical outcome were similar, our results shown that modified procedure may have the shorter operation time, postoperative hospital stay, and operation time for plate removal and less blood loss, which may bring potential clinical benefits to patients.

show abstract

Nuss procedure for repair of pectus excavatum after failed Ravitch procedure in adults: indications and caveats

Cited by 13 publications

References 13 publications

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures

Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

Contact Info

Product

Resources

About