Nuss Bar Removal Research Articles

Cardiorespiratory Function after Operation for Pectus Excavatum

We performed a review of current data to determine the effect that operation has on pulmonary function, aerobic capacity, and stroke volume in patients with pectus excavatum. Two reviewers independently assessed clinical trials and collected data on interventions and outcomes. To qualify for inclusion, a study had to include preoperative and postoperative assessment, provide outcomes in either a published percentile or qualified matched control form to control for interval growth, and include only original patient groups. Postoperative total lung capacity for patients who had Ravitch repair was significantly lower (SMD, 0.71 [CI -1.06, -0.36]; I(2) = 19.6%) than preoperative. Based on 2 studies after removal of the Nuss bar, FEV(1) was significantly increased from preoperative values (SMD, 0.39 [CI, 0.03, 0.74]; I(2) = 0%). Stroke volume increased after surgery (SMD, 0.40 [CI, 0.10, 0.70]; I(2) = 0%) after Ravitch repair. There was a trend toward improved exercise tolerance, but it was not statistically significant. Total lung capacity was decreased after Ravitch repair, and FEV(1) was increased after Nuss bar removal. Stroke volume may be increased after Ravitch repair. Exercise tolerance was not improved after either type of surgical repair.

Lung Function after the Minimal Invasive Pectus Excavatum Repair (Nuss Procedure)

BackgroundThe Nuss procedure was introduced at our center in 1999. The operation was mainly performed for cosmesis. Little information is available regarding the influence of this operation on lung function.MethodsThe aim of this study, a prospective analysis, was to analyze the effect of the Nuss procedure on lung function variables. Between 1999 and 2007 a total of 203 patients with pectus excavatum were treated with the Nuss procedure, of whom 145 (104 male, 41 female) were located at Emma Children’s Hospital. In the latter subset of consecutive patients, static lung function variables [total lung capacity (TLC), functional residual capacity (FRC), vital capacity (VC)] and dynamic lung function variables [forced expired volume in 1 s (FEV1), maximum expiratory flow (MEF50)] were performed using spirometry and body box measurements at four time points: prior to operation (T0), 6 months after the Nuss procedure (T1, n = 111), prior to removal of the Nuss bar (T2, n = 74), and 6 months after removal (T3, n = 53). All values were expressed as a percent of normal values for sex, age, and height. Results were compared with a paired-samples t-test, with the level of significance at p = 0.05.ResultsAt 6 months after bar insertion the TLC, FRC, VC, FEV1, and MEF50 showed a significant increase; and prior to bar removal the FRC and MEF50 showed significantly increased values. At 6 months after Nuss bar removal, none of the lung function variables showed any significant change compared to the preoperative values.ConclusionAfter the Nuss procedure for pectus excavatum, there was no improvement of pulmonary function, but neither was the patient’s pulmonary function harmed by resolving a largely cosmetic problem.

Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure

Background/Purpose Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. Methods The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV 1), and forced expiratory flow (FEF 25%-75%). Results Preoperatively, FVC and FEV 1 medians were lower than the normal by 13%, whereas the FEF 25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post–bar removal improvement than the younger patients. An older patient with a preoperative FEF 25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF 25-75 of 97%, indicating almost complete normalization for this function. Conclusions These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.