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OBJECTIVE: Aims: Pectus excavatum (PE) is a congenital condition characterized by inward depression of the chest wall. Significant PE can lead to heart compression and can affect exercise tolerance. Minimally invasive NUSS procedure is now replacing the open surgery (Ravitch). We present the outcomes of this novel technique.
METHODS: We retrospectively followed a series of 47 patients, mean age 38 (15-68, mode and median 27), 4% female, who underwent NUSS procedure at the Heart Hospital, London, UK, between February 2010 and July 2013. We recorded the reasons for the operation, history of cardio-respiratory symptoms, results of echocardiogram, pre and post-surgery chest radiographs and CT chest images, the length of hospital stay, need for analgesia, complications and planned completion bar removal.
RESULTS: Reasons for the procedure: 72% cosmetic reasons alone, 19% breathlessness on exertion, 4% palpitations, 4% chest pain on exertion and 9% other chest pain. 4 patients had evidence of right ventricular compression on CT with normal function on echocardiography. Bar number and size: 50% 1 bar, 50% 2 bars, 42% size 10 and 35% size 11. The mean length of hospital stay was 4.7 days (3-21). Requirement for analgesia: mean 17 days (5-28), 45% required opiate analgesia, 38 % tramadol, 62% required 3 or more types of analgesia. Complications (patient number): 5 incision site cellulitis (2 requiring intravenous antibiotics), 14 pleural effusions (12 resolved spontaneously, 2 required drainage), 16 small pneumothoraxes which resolved spontaneously, 4 bar displacements requiring re-do NUSS. Completion bar removal was performed in 2 patients at 2 and 3 years post insertion respectively.
CONCLUSIONS: Minimally invasive NUSS procedure is a safe and effective alternative to the open correction of PE. It is successfully used in different age groups and in both genders. Longer follow-up is needed to assess how long-lasting its effects are following bar removal.