Surgical treatment and outcomes of pectus arcuatum

Objective: Pectus arcuatum is a rare variant of pectus deformities that can cause varying degrees of cardiac compression. A review of the evaluation, surgical repair, and outcomes of pectus arcuatum is presented.

Methods: A retrospective review of all patients undergoing surgical treatment of pectus arcuatum at a single institution was conducted between January 1, 2010, and May 31, 2024. Descriptive statistics and surgical techniques are presented.

Results: Twenty patients underwent pectus arcuatum repair (median age, 22.9 years; 55.0% males, median Haller index 2.8 [interquartile range {IQR}, 2.2, 3.6]) during the study period. Preoperatively, all patients were bothered by their chest appearance and symptomatic, with the most common symptoms being exercise intolerance (95.0%), chest pain (90.0%), and shortness of breath (90.0%). Preoperatively, cardiopulmonary exercise testing was performed in almost half the patients with abnormal findings (median maximum oxygen consumption, 67.0% of predicted). A hybrid approach with sternal osteotomy and minimally invasive pectus excavatum repair was utilized in 19 out of 20 cases, with 1 case requiring sternal osteotomy only. Single wedge osteotomy was sufficient in most cases (70.0%). Median intraoperative time was 3.5 hours (IQR, 3.1, 4.2 hours). The adoption of cryoablation in 2018 significantly reduced hospital stays, from 5.0 days (IQR, 4.5, 6.0 days) to 3.0 days (IQR, 2.8, 5.0 days) (P < .001). At follow-up, all reported cosmetic satisfaction and most reported symptom improvement.

Conclusions: Pectus arcuatum can be successfully repaired with a hybrid surgical approach involving sternal osteotomy and Nuss bar placement. Symptomatic patients should be considered for surgery, with postoperative improvement expected.