Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (≥30 Years).
BACKGROUND
Minimally invasive repair of pectus excavatum (MIRPE) has become standard for pediatric and young adult patients, but its use for older adults is controversial.


METHODS
We retrospectively reviewed electronic medical records of adults (≥18 years of age) who underwent MIRPE from January 1, 2010, through April 30, 2015, and collected demographic data, operative details, and information about outcomes. Cardiac function was measured before and after repair by intraoperative transesophageal echocardiography. We divided patients by age: 18 to 29 years of age and 30 years of age and older.


RESULTS
Of 361 patients, 207 were 30 or older (mean, 40 years; range, 30 to 72 years; 71.5% men). Of the older patients, 151 had primary repairs. MIRPE was successfully used in 88.7% of patients older than 30 years of age versus 96.5% of those 18 to 29 years of age. For patients 30 years of age and older, open-cartilage resection, sternal osteotomy, or both was more common with increasing age (mean, 47.8 years versus 39.5 years; p = 0.0003) and higher mean Haller index (7.7 versus 5.5; p = 0.0254). Mean operative time for MIRPE was significantly longer for older patients (≥30 years of age) compared with younger adults (121 [60 to 224] minutes versus 111 [62 to 178] minutes; p = 0.0154). Right ventricular output increased 65.2% after repair in older adults. Although greater, the frequency of bar rotation requiring reoperation was not significantly increased in the older patients (p = 0.74).


CONCLUSIONS
The majority of adult patients with PE can have successful repair with modified MIRPE. The use of cartilage or sternal osteotomy, or both, increased with patient age and defect severity.
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona. Electronic address: jaroszewski.dawn@mayo.edu.
Dawn E
DE
Jaroszewski
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
MennatAllah M
MM
Ewais
Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona.
Chieh-Ju
CJ
Chao
Department of Radiology, Mayo Clinic Hospital, Phoenix, Arizona.
Michael B
MB
Gotway
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Jesse J
JJ
Lackey
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Kelly M
KM
Myers
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Marianne V
MV
Merritt
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Stephanie M
SM
Sims
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Lisa E
LE
McMahon
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
David M
DM
Notrica
D000328:Adult; D000368:Aged; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011182:Postoperative Care; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery