gms | German Medical Science

Objective: Patients with congenital fibrous tissue abnormalities may present with severe chest wall deformities with concomitant cardiac diseases necessitating surgery. This report analyses the outcome of simultaneous performance of cardiac surgery and reconstruction of chest wall deformities.

Patients: Between 1993 and 2013, 17 patients (median age 24.3, range 2-64, years) presented with heart diseases of whom 13 (76.4%) had aortic root and valve abnormalities which warrant surgery. Twelve patients had Marfan syndrome. Fifteen patients had severe pectus excavatum while 2 had pectus carinatum. All patients underwent perioperative echocardiography, cardiac computerized tomography and pulmonary function tests. Approach was midline sternotomy using cardiopulmonary bypass, under normothermia/moderate systemic hypothermia to treat the specific cardiac disease. Single-stage chest wall reconstruction for pectus excavatum and carinatum was performed. Ravitch technique was employed from 1993 until 1998 in 3 patients. It consisted of excision of all deformed cartilages from the perichondrium, division of the xiphoid and intercostal bundles from the sternum and transverse sternal osteotomy. The sternum was displaced anteriorly and held into position by using wires or with a Rehbein splint. Since 2000, Robiczek's repair technique was individually applied based on the extent of the deformity. Proximal and distal (to remove the xiphoid) horizontal sternotomy with subepichondrial resection of appropriate segments of the rib cartilages around the rim of the funnel was performed. Three to four double layer strips of meshgrafts placed under the sternum were sutured to the lateral rib stumps under moderate tension.

Results: No postoperative morbidity nor mortality occured. During a median follow-up of 9.3 (range 1.4-21.3) years, there was a significant improvement in cardiac function and hemodynamic status. Chest wall stability was maintained and cosmetic outcome of reconstruction was satisfactory, without residual chest wall depression. Freedom from reoperation is 100%. However, lung function, assessed by inspiratory vital capacity and forced expiratory volume was decreased until 6 months postoperatively which may be due to extensive scarring of the anterior chest wall. Survival rate is 94.4%.

Conclusion: Simultaneous cardiac surgery and chest wall reconstruction of chest wall deformities can be performed without adverse events and with highly satisfactory long-term outcome.