Vacuum bell therapy for pectus excavatum: a retrospective study

BACKGROUND

Pectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables associated vacuum bell therapy for patients with pectus excavatum.

METHODS

Retrospective case-control study in a single center between July 2018 and February 2022, including patients with pectus excavatum treated with vacuum bell. Follow-up was continued to September 2022. The Haller index and Correction index was calculated before and after treatment to analysis the effectiveness of vacuum bell therapy.

RESULTS

There were 98 patients enrolled in the treatment group, with 72 available for analysis, and the follow-up period ranged from 1.1 to 4.4 years (mean 3.3 years). When analyzing with the Haller Index, 18 patients (25.0%) showed excellent correction, 13 patients (18.1%) achieved good correction, and 4 patients (5.6%) had fair correction. The remaining patients had a poor outcome. Characteristics predicting a non-poor prognosis included initial age ≤ 11 years (OR = 3.94, p = 0.013) and patients with use over 24 consecutive months (OR = 3.95, p = 0.013). A total of 9 patients (12.5%) achieved a CI reduction below 10. Patients who started vacuum bell therapy at age > 11 had significantly less change compared to those who started at age ≤ 11 (P < 0.05). Complications included chest pain (5.6%), swollen skin (6.9%), chest tightness (1.4%) and erythema (15.3%).

CONCLUSIONS

A certain percentage of patients with pectus excavatum can achieve excellent correction when treated with pectus excavatum therapy. Variables predicting better outcome including initial age ≤ 11 years both in HI and CI and vacuum bell use over 24 consecutive months in HI. In summary, pectus excavatum is an emerging non-invasive therapy for pectus excavatum and will be widely performed in a certain group of patients.

Failed preoperative vacuum bell therapy does not affect outcomes following minimally invasive repair of pectus excavatum

PURPOSE

It is unknown if failed preoperative vacuum bell (VB) treatment in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), delays repair and/or affects postoperative outcomes.

METHODS

A retrospective data analysis including all consecutive patients treated at one single institution undergoing MIRPE was performed between 2000 and 2016. Patients were stratified into preoperative VB therapy versus no previous VB therapy.

RESULTS

In total, 127 patients were included. Twenty-seven (21.3%) patients had preoperative VB treatment for 17 months (median, IQR 8-34). All 27 patients stopped VB treatment due to the lack of treatment effect. Eight (47.1%) of 17 assessed VB patients showed signs of skin irritation or hematoma. VB treatment had no effect on length of hospital stay (p = 0.385), postoperative complications (p = 1.0), bar dislocations (p = 1.0), and duration of bar treatment (p = 0.174). Time spent in intensive care unit was shorter in patients with VB therapy (p = 0.007). Long-term perception of treatment including rating of primary operation (p = 0.113), pain during primary operation (p = 0.838), own perspective of look of chest (p = 0.545), satisfaction with the procedure (p = 0.409), and intention of doing surgery again (p = 1.0) were not different between groups.

CONCLUSIONS

Failed preoperative VB therapy had no or minimal effect on short-term outcomes and long-term perceptions following MIRPE.

Is vacuum bell therapy effective in the correction of pectus excavatum?

A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: 'In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?' Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.