Multicenter Study of Pectus Excavatum, Final Report: Complications, Static/Exercise Pulmonary Function, and Anatomic Outcomes - 17/11/13
, Robert B. Mellins, MD d, Robert C. Shamberger, MD, FACS e, Karen K. Mitchell, RN a, M. Louise Lawson, PhD f, Keith T. Oldham, MD, FACS g, Richard G. Azizkhan, MD, FACS h, Andre V. Hebra, MD, FACS i, Donald Nuss, MB, ChB, FACS a, b, Michael J. Goretsky, MD, FACS a, b, Ronald J. Sharp, MD, FACS j, George W. Holcomb, MD j, Walton K.T. Shim, MD, FACS k, Stephen M. Megison, MD l, R. Lawrence Moss, MD, FACS m, Annie H. Fecteau, MD, FACS n, Paul M. Colombani, MD, FACS o, Dan Cooper, MD, FACS p, Traci Bagley, RN, BSN a, Amy Quinn, MS a, Alan B. Moskowitz, MS a, James F. Paulson, PhD b, cAbstract |
Background |
A multicenter study of pectus excavatum was described previously. This report presents our final results.
Study Design |
Patients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing.
Results |
Of 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p < 0.001 for each). VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests.
Conclusions |
There is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations and Acronyms : FEV1, FVC, HR, VE, VCO2, VO2, WR
Mappa
| Disclosure Information: Dr Nuss has consulted for Biomet Microfixation, Inc. This study was supported by a grant from Children's Health Foundation (Children's Hospital of The King's Daughters) with additional support from Biomet Microfixation, Inc., formerly Walter Lorenz Surgical, Jacksonville, FL. Neither Children's Health Foundation nor Biomet was involved with conduct of the study, data analysis, or dissemination. |
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| This trial has been registered at www.clinicaltrials.gov (identifier NCT00236132). |
Vol 217 - N° 6
P. 1080-1089 - dicembre 2013 Ritorno al numero
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