Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Department of Pediatric Surgery, University Children's Hospital, University of Basel, Basel, Switzerland.
Eur J Cardiothorac Surg. 2017 Oct 1;52(4):710-717. doi: 10.1093/ejcts/ezx221.
Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population.
Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed.
Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality.
Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres.
曾因心脏手术而行正中开胸的漏斗胸（pectus excavatum，PE）患者，其 PE 修复具有独特的挑战。由于担心胸骨粘连和心脏损伤，推荐采用开放式修复。我们报告了多中心应用胸骨下 Nuss 棒修复此类患者的经验。
Chest Wall International Group 的外科医生被询问了关于在有心脏手术正中开胸史的患者中应用胸骨下 Nuss 棒修复 PE 的经验和回顾性数据（2000 年 11 月至 2015 年 8 月）。进行了描述性分析。
从 14 个中心获得了 75 例患者的数据。PE 修复时的中位年龄为 9.5 岁（四分位间距 10.9），Haller 指数的中位数为 3.9（四分位间距 1.43）；56%的患者为男性。距心脏手术后行 PE 修复的中位时间为 6.4 年（四分位间距 7.886）。在放置支撑棒之前，有 12 例（16%）患者需要再次正中开胸：7 例预防性，5 例紧急性。在 34 例患者（45%）中使用胸骨抬高术，在 67 例患者（89%）中使用胸腔镜。9 个中心（64%）可随时行体外循环下心脏备用。5 例（7%）发生了意外的心脏损伤，但无死亡病例。
在多个不同的机构中，胸骨下 Nuss 棒被应用于曾因心脏手术而行正中开胸的 PE 患者的修复。报告了一些技术改良，这些改良可能有助于修复。7%的病例发生了心脏损伤，因此发生并发症时应具备适当的资源。少数中心报告预防性再次正中开胸。
