Staged management of pectus carinatum

AimThe aim was to report the treatment of pectus carinatum with a novel Argentine brace and operation.MethodsThe bracing and clinical data of 137 consenting pectus carinatum patients treated between October 2008 and December 2011 were reviewed for outcome. Institutional approval was obtained. Data are reported as median (range).ResultsMedian age 122 bracing patients was 14 (10–28) years with 67 (55%) progressing under active treatment. Five patients (4%) were lost to follow-up, and thirteen (11%) failed treatment. Thirty-seven patients (30%) exhibited flattening of the sternum after 6 (1–24) months without surgery. After flattening, patients then wore the brace for progressively fewer hours each day as a “retainer” for 5 (3–19) months. Five patients (4%) experienced recurrence 5 (3–7) months after brace treatment was discontinued. Complications were limited to transient skin breakdown in nine patients. Three of the 13 Argentine brace failures and 15 other pectus carinatum patients were treated surgically. Thirteen underwent Abramson's minimally invasive operation and five an open repair, all with good initial correction. For Abramson repairs, seven patients have had bars removed, with results rated as excellent (n = 4), good (n = 2), and failure (n = 1, converted to open with excellent result later). In three patients with stiff chests, costal cartilage was resected thoracoscopically during the Abramson repair with measurably improving compliance.ConclusionStaged treatment of pectus carinatum allows most teenagers to be managed non-operatively. For patients who fail bracing or are not amenable to bracing, minimally invasive surgical treatment for pectus carinatum is a viable option.