Surgery with the Pectus Up method is indicated for Pectus Excavatum patients in the following situations:
- Symptomatic patients
- Haller Index equal to or greater than 3.25
- Clear progression in the chest deformity with symptoms associated with Pectus Excavatum
- Paradoxical or reverse breathing
- Decreased lung function with a pattern of restrictive or obstructive lung disease..
- Cardiac abnormalities (cardiac displacement or compression, mitral prolapse, decreased left ventricular ejection volume, arrhythmia)
- Chest or low-back pain, related to relevant acquired bone deformities secondary to the Pectus Excavatum
- Body image distortion.
- Relevant psychological effects
- Failure of previous surgical procedures.
Four or more of these situations normally coexist in the same patient.
For pediatric patients, surgical repair of the Pectus Excavatum was previously recommended in symptomatic cases at the earliest. However, it has recently been shown that the results are not so positive in very young children and, for this reason, it is currently recommended to delay the age of surgery, establishing the optimal age from 8 years old on.
Main criteria for the indication of a Pectus Up in a Pectus Excavatum patient:
Types of patients:
- Age: As in any surgical technique for the Pectus Excavatum and in order to prevent other abnormalities as a consequence of the pathology itself, the ideal age would be between the ages of 12 to 16 years old. The Pectus Up, being an extrathoracic product and being anchored only in the central area of the sternum, can be implanted in patients of different ages:
- Infant and prepubertal age: the surgery can be performed on a patient the age of 8, since the implant does not prevent the normal growth of the chest.
- Adults: cases have been made up to 46 year-old patients.
- In these cases, the surgeon assesses the level of flexibility of the rib cage and, at his sole discretion, he/she may indicate the Pectus Up.
- In cases where a remarkable level of stiffness is evident, the surgeon recommends the patient to use the Vaccum Bell for a few months to improve flexibility at the time of the surgery.
- Asymmetry: As in any surgical technique for this pathology, the less asymmetry the patient has the less complexity of the surgery and better results, a priori
- Symmetric Pectus Excavatum patients
- Patients with a mild and moderate degree of asymmetry.
- Pectus Up is used in patients with a high degree of asymmetry, or a significant rotation of the sternum. In some of these cases, it is recommended to use sternal retractors or a combination of the technique with a mini Ravitch.
- Patients with a grand canyon type Pectus Excavatum are not advised to undergo the Pectus Up technique.
- Haller Index: It is recommended to be equal to or greater than 3.2, although this index should not be the only or main value for the indication of a Pectus Up.
- Other indices such as the Correction Index must be valued
- Other indices… MRI, 3D external scan, SDI.
- In the event that the value of the indices was not the reason for the surgical indication, other conditions of the patient clinically related to Pectus Excavatum should be assessed:
- Decreased lung function according to ergo-spirometry (stress spirometry).
- Chest or lower back pain associated with an acquired poor bone formation secondary to Pectus Excavatum.
- Recurrent major respiratory infections (bronchopneumopathies that have required hospitalization for treatment) without other pathologies causing them, at the clinical judgement.
- Heart displacement diagnosed by echocardiogram.
- Mitral prolapse echocardiogram-proved.
- Atrium compression echocardiogram-proved.
- Decreased ejection volume of the left ventricle.
- Cardiac arrhythmia ECG-proven.
- Psychological effects.
- Marfan patients: In some cases, if the patient has undergone surgery for a cardiac disease, the Pectus Up should be implanted after a sternal raise with an external retractor, as there is a solution of continuity that prevents the sternum from being raised using the standard technique.
- Patient affected by Pectus Excavatum having undergone previously performed techniques without success.
- Being extrathoracic, The Pectus Up can be a good alternative.
- In some of these cases, the Pectus Up should be implanted after a sternal raise with an external retractor, as there is a solution of continuity in the sternum itself.
No surgery should be performed if a chest Computed Tomography (CAT) scan in expiration, or an MRI is not previously available in pediatric patients, to assess the degree of asymmetry, position and thickness of the sternum and the Haller or other indices.