title: Cardiac surgery and repair of pectus deformities: When and how?
abstract: OBJECTIVE
  There is currently a lack of recommendations about patients with pectus deformities requiring cardiac surgery. This study reports the results of our surgical strategy on this issue.
  
  
  METHODS
  Eleven patients, from three centers treated over a 9-year period were included in this study. Pectus deformities were operated with a modified Ravitch procedure. In the case of pectus excavatum repair and concomitant cardiac surgery, subperichondrial resection of abnormal rib cartilages was always performed before the sternotomy and an easily removable retrosternal metallic strut was inserted at the end of the procedure ensuring anterior chest wall stability. During follow-up patients had to estimate their current appearance with a numeric scale ranging from 0 to 100.
  
  
  RESULTS
  Mean age was 27 ± 9.4 years. Pectus excavatum was present in 8 patients and pectus arcuatum in 3. There were 6 Marfan syndrome patients. Nine patients had concomitant surgery and, 2 underwent pectus repair after a history of cardiac surgery. There was no operative mortality. In the case of concomitant surgery, heart exposure through median sternotomy was facilitated by abnormal rib cartilage resection. Median follow-up was 54 months (range 16.7-119.7). Mean cosmetic result evaluated by the patients was 97.3 (±2.5).
  
  
  CONCLUSIONS
  In adults, concomitant scheduled surgery is reliable and offers excellent long-term cosmetic results. Moreover, it allows a better thoracic exposition with no added perioperative risk. The modified Ravitch technique seems more adequate in these patients as it can be used in all types of pectus deformities.
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France. Electronic address: ilirhysi@gmail.com.
authors.forename: Ilir
authors.initials: I
authors.lastname: Hysi
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: André
authors.initials: A
authors.lastname: Vincentelli
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Juthier
authors.affiliation: Department of Thoracic Surgery, Valenciennes Hospital, Valenciennes, France.
authors.forename: Lotfi
authors.initials: L
authors.lastname: Benhamed
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: Carlo
authors.initials: C
authors.lastname: Banfi
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Rousse
authors.affiliation: Department of Cardiac Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Frapier
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Doguet
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Wurtz
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac surgery; Cardiopulmonary bypass; Pectus deformities