Our Summary

This research paper discusses Pectus excavatum, a condition where a person’s chest appears sunken or hollowed out. This condition often occurs alongside heart and connective tissue diseases that require heart surgery. Sometimes, the chest deformity is discovered during heart surgery, or it can worsen after heart surgery. The paper aims to educate heart surgeons about the impacts of this condition, when and how to repair it, and the outcomes for patients who need this type of repair.

The researchers reviewed existing literature and found that the risks of complications from repairing the chest deformity, whether during heart surgery or afterward, are low when performed by experienced surgeons. Additionally, patients reported improved heart and lung function and relief from symptoms. The paper suggests that if a patient needs both heart and chest deformity surgery, they should be done together if possible, especially since the chest deformity can worsen after heart surgery.

For patients who may have instability or potential bleeding, the researchers recommend delaying the closing of the sternum (chest bone). For those who need chest deformity repair after heart surgery, a protective layer should be added to the heart. For those who had heart surgery without a protective layer added, a combined (“hybrid”) approach is safe and effective.

The researchers conclude that patients undergoing heart surgery who also have a chest deformity should be considered for concurrent or staged chest deformity repair. If a staged procedure is planned, a protective barrier should be placed before closing the chest.

FAQs

  1. What is the physiologic impact of pectus excavatum in patients requiring cardiac surgery?
  2. What are the potential complications of pectus repair in the setting of cardiac surgery?
  3. What is the recommended approach for those undergoing pectus repair after cardiac surgery without a membrane placed?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about cardiac surgery is to consider concomitant or staged pectus repair if pectus excavatum is present. This can help improve cardiopulmonary function and alleviate symptoms. Additionally, in cases where pectus repair is planned after cardiac surgery, ensuring that a barrier membrane is placed before chest closure can help protect the heart during the procedure. It is important to discuss these options with your surgeon to determine the best course of action for your individual situation.

Suitable For

Patients who are typically recommended cardiac surgery include those with congenital heart disease, connective tissue diseases, and other cardiac conditions that require surgical intervention. Additionally, patients with pectus excavatum, a common chest wall deformity, may also be recommended for cardiac surgery if it is impacting their cardiopulmonary function. It is important for cardiac and congenital surgeons to consider the potential benefits of concomitant or staged pectus repair in patients undergoing cardiac surgery to improve outcomes and reduce complications.

Timeline

Before cardiac surgery:

  1. Patient is diagnosed with a congenital heart disease or other cardiac condition requiring surgery.
  2. Patient may also have pectus excavatum, which may be incidentally noticed or become more significant over time.
  3. Preoperative evaluations and tests are conducted to assess the patient’s overall health and determine the best course of treatment.

After cardiac surgery:

  1. Patient undergoes cardiac surgery, which may involve procedures such as bypass surgery, valve repair or replacement, or heart transplant.
  2. If pectus excavatum is present or becomes more significant after cardiac surgery, the patient may be considered for pectus repair.
  3. Concomitant pectus and cardiac surgery may be performed by experienced surgeons to minimize risks and optimize outcomes.
  4. In cases where pectus repair is delayed after cardiac surgery, measures such as delayed sternal closure or placement of a barrier membrane may be taken to protect the heart and optimize recovery.
  5. Patients undergoing staged pectus repair after cardiac surgery may benefit from a “hybrid” approach that incorporates both cardiac and pectus repair techniques for optimal results.

What to Ask Your Doctor

  1. What is the impact of my pectus excavatum on my cardiac condition and overall health?

  2. What are the indications for pectus repair in my case, and how will it affect my cardiac surgery?

  3. What are the potential risks and complications associated with pectus repair, particularly in conjunction with cardiac surgery?

  4. Who will be performing the pectus repair, and what is their experience with this type of procedure?

  5. Should I consider having concomitant pectus repair with my cardiac surgery, or should it be done as a staged procedure?

  6. How will the pectus repair be performed in relation to my cardiac surgery, and what are the expected outcomes?

  7. What measures will be taken to protect my heart during and after the pectus repair surgery?

  8. How will my recovery and rehabilitation differ with both cardiac surgery and pectus repair?

  9. What follow-up care and monitoring will be needed after both surgeries to ensure optimal outcomes?

  10. Are there any specific lifestyle changes or precautions I should take after undergoing both cardiac surgery and pectus repair?

Reference

Authors: Stephens EH, Dearani JA, Jaroszewski DE. Journal: Ann Thorac Surg. 2023 May;115(5):1312-1321. doi: 10.1016/j.athoracsur.2023.01.040. Epub 2023 Feb 11. PMID: 36781097