Effect of minimally invasive repair of pectus excavatum on postoperative chest flatness, cardiopulmonary function, and bone metabolism indexes in children at different ages

Abstract

Objective: To observe the effects of minimally invasive surgical repair of pectus excavatum (NUSS) on the degree of chest flatness, cardiopulmonary function, and bone metabolism indexes in children of various age groups.

Methods: In this retrospective study, 62 children with pectus excavatum admitted to our hospital were divided into two groups: group A (3-12 years old) and group B (>12 years old), with 31 cases in each group. All of them were treated with NUSS. The treatment effectiveness, perioperative indexes (operation time, blood loss, ground time, and hospitalization time), degree of chest flatness, cardiopulmonary function, bone metabolism indicators, and complications were compared between the two groups.

Results: There was no significant difference between patients in the two groups in terms of operation time, blood loss, ground time, and hospitalization time (all P>0.05). The overall response rate to treatment in group A (93.55%) was higher than that of group B (70.97%; P<0.05). Three months after the operation, the chest flatness as well as serum alkaline phosphatase and its bone isoform levels in both groups were decreased, while left ventricular ejection fraction, cardiac index, stroke volume, FEV1, and peak expiratory flow levels were increased compared to before the operation, and the improvement in the above indicators of group A was better than Group B (all P<0.05). There was no significant difference in the incidence of complications between the two groups (16.13% vs. 9.68%; P>0.05).

Conclusion: NUSS surgery can achieve satisfactory results in treating children with pectus excavatum at different ages. However, in a certain age range, a younger age indicates a better effect. NUSS procedure effectively improves postoperative flat chest, cardiopulmonary function, and bone metabolism indexes.

Keywords: Minimally invasive surgery of pectus excavatum; bone metabolism index; cardiopulmonary function; complications; different ages; the degree of flat chest.

Figure 1

Comparison of perioperative related indexes between the two groups. A: Operation time (min); B: Blood loss (mL); C: Ground activity time (d); D: Hospitalization time (d).

Figure 2

Comparison of preoperative and postoperative chest flatness degree between the two groups. Compared to before the operation, ***P<0.001; compared to group B, ###P<0.001.

Figure 3

Contrast radiographs of a 6-year-old child before and after surgery. A: Before the operation; B: 1 month after the operation; C: 3 months after the operation.

Figure 4

Contrast radiographs of a 14-year-old child before and after surgery. A: Before the operation; B: 1 month after the operation; C: 3 months after the operation.