Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis

Zhenguang Chen,Honghe Luo,Beilong Zhong,Ela Bella Amos,Jianyong Zou,Chunhua Su,Yiyan Lei

doi:10.1186/1749-8090-7-101

Abstract

BackgroundPectus excavatum (PE) is a common chest wall malformation, with surgery being the only method known to correct the defect. Although the Nuss and Ravitch procedures are commonly used, there is no consensus as to whether surgical repair improves pulmonary function. We therefore investigated whether pulmonary function recovers after surgical repair, and if recovery is dependent on the type of procedure or time after surgery.MethodsLiterature searches were performed using PubMed, EMBASE, Health Periodicals Database, and CNKI (Chinese National Knowledge Index) from January 1990 to December 2007. The following keywords were used: pectus excavatum, chest wall deformity, funnel chest, pulmonary function, respiratory, lung function, and pectus severity index. The primary outcome of interest was possible changes in pulmonary function following surgical repair.ResultsMeta-analysis of 23 studies showed that, although there was evidence of statistically significant heterogeneity among studies (Chi-square, 17.11, p < 0.05), changes in pulmonary functional indices, including forced expiratory volume over 1 s (FEV1), forced vital capacity (FVC), vital capacity (VC), and total lung capacity (TLC), were similar 1 year after the Ravitch and Nuss procedures. Several years after surgery and bar removal, however, the changes in pulmonary functional indices significantly favored the Nuss procedure.ConclusionsPulmonary function tends to improve after the surgical correction of pectus excavatum. Although the Nuss procedure was not significantly better 1 year after surgery, long-term postoperative pulmonary function improvement was significantly better after bar removal.

Highlights

Pectus excavatum (PE) is a common chest wall malformation, with surgery being the only method known to correct the defect
The more important aspect of the pathophysiology of PE is that the depth and extent of the sternal depression determine the degree of pulmonary compression, which in turn determines the degree of incapacitation, often causing impairment of pulmonary function [7,8]
We analyzed whether pulmonary functional recovery occurred after the surgical correction of PE, and whether this recovery differed by type of procedure performed or by time after surgery

Summary

Introduction

Pectus excavatum (PE) is a common chest wall malformation, with surgery being the only method known to correct the defect. Pectus excavatum (PE) is a common congenital deformity of the anterior chest wall in children and adolescents [1] It is not life-threatening and does not manifest in severe functional pathophysiology of the thoracic organs, the chest appears concave and the heart is commonly displaced to the left midaxillary line slightly below the axilla. The more important aspect of the pathophysiology of PE is that the depth and extent of the sternal depression determine the degree of pulmonary compression, which in turn determines the degree of incapacitation, often causing impairment of pulmonary function [7,8]. In contrast to current understanding of cardiac pathophysiology in PE, it is unclear whether pulmonary function recovers after the surgical correction of PE

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Conclusion