Repair of pectus excavatum deformities: 30 years of experience with 375 patients

Objective To review the surgical experience with pectus excavatum chest deformities a t UCLA Medical Center during a 30-year period. Background Pectus excavatum is a relatively common malformation that is often symptoma tic; however, children's physicians often do not refer patients for surgica l correction. Methods Hospital records from 375 patients who underwent repair of pectus excavatum deformities between 1969 and 1999 were reviewed. Decrease in stamina and e ndurance during exercise was reported by 67%; 32% had frequent respiratory infections, 8% had chest pain, and 7% had asthma. The mean pectus severity score (width of chest divided by distance between posterior surface of ster num and anterior surface of spine) was 4.65 (normal chest = 2.56). All pati ents had marked cardiac deviation into the left chest. Repair was performed with subperiosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a steel strut for 6 months. Repair was performed on 177 children before age 11 years; 38 adults with severe symptoms underwent repair. Results The mean hospital stay was 3.1 days. With a mean follow-up of 12.6 years, a ll patients with preoperative respiratory symptoms, exercise limitation, an d chest pain experienced improvement. Vital capacity increased 11% (mean) w ithin 9 months in 35 patients evaluated. There were no deaths. Complication s included hypertrophic scar formation (35), atelectasis (12), pleural effu sion (13), recurrent sternal depression (5), and pericarditis (3). More tha n 97% had a very good or excellent result. Conclusion Pectus excavatum deformities can be repaired with a low rate of complicatio ns, a short hospital stay, and excellent long term physiologic and cosmetic results.