Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY3:55 p.m. SIMULTANEOUS SCIENTIFIC SESSION –GENERAL THORACIC SURGERYRoom 302–306, Hynes Convention CenterModerators: James D. LuketichBryan F. Meyers18. Minimally Invasive Repair of Pectus Excavatum: 10-Year Appraisalwith 1,170 PatientsHyung Joo Park, Jongho Cho, Kwang Taik Kim, Young Ho ChoiKorea University Medical Center, Seoul, South KoreaInvited Discussant: Daniel L. MillerOBJECTIVE: The minimally invasive repair of pectus excavatum (MIRPE) wasintroduced by Nuss in 1998. Since then, serious problems associated with lack ofexperience and insufficient surgical techniques have hindered this procedure toprogress. We started this new procedure in 1999, and to overcome these obstacles,the concepts of the repair as well as surgical techniques have been modified continuously.As a result, the morphology-tailored approach with a diverse bar-shaping,bar fixation techniques, and techniques for adults were developed. To reset themost current status of the MIRPE, our 10-year experience was appraised.MONDAYAfternoonMETHODS: A single surgeon (HJP) experience with 1,170 consecutive pectusexcavatum patients between August 1999 and September 2008 was analyzed. Allpatients treated with the author’s modifications were enrolled to assess the efficacyof repair techniques and surgical outcomes.RESULTS: The mean age of the patients were 10.3 years (range: 16 months to 51years). Male to female ratio was 4.1. Adult patients (age = />15 years) were331(28.3%). 491 patients (42.0%) had bar removal mean of 2.5 years (range: 3months to 7 years) after the bar placement. To repair the eccentric and unbalancedasymmetry, the asymmetric bar (n = 471, 40.3%), the seagull bar (n = 219, 18.7%),and the crest compression technique (n = 119, 10.2%) were employed. Post-repairsymmetry of the asymmetric types was verified with the asymmetry index (AI)(Pre: 1.10 vs. Post: 1.02, p < 0.001). Techniques for the adults were the compound bar(n = 244, 20.9%) and the crane technique (n = 397, 33.9%). Changes of complicationrates between 1999 and 2008 were: total complication (15/51, 29.4% vs. 9/185,4.9%, p < 0.001), pneumothorax (10/51, 19.6% vs. 1/185, 0.5%, p < 0.001), and bardisplacement rate (4/51, 7.8% vs. 0/185, 0%, p = 0.037). Reoperation rate alsodecreased (7/51, 13.7% vs. 1/185, 0.5%, p < 0.001). (Figure1). Satisfaction outcomeswere excellent in 1,085/1170 (92.7%), good in 69/1,170 (5.9%), and fair in 16/1,170(1.4%). After the bar removal, 3 patients (0.6%) had minor recurrence, and two ofthem were undergone reoperation.103