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Cardiovascular Function Following Surgical Repair of Pectus Excavatum^*

A Metaanalysis

^* From the Human Performance Laboratory (Mr. Malek, Dr. Housh, and Mr. Beck), Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE; the Department of Psychology (Dr. Berger), Claremont Graduate University, Claremont, CA; and the Departments of Psychology (Dr. Marelich) and Kinesiology (Dr. Coburn), California State University-Fullerton, Fullerton, CA.

Correspondence to: Moh H. Malek, MS, CSCS, Human Performance Laboratory, Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 110 Ruth Leverton Hall, Lincoln, NE 68583-0806; e-mail: mmalek{at}unlserve.unl.edu

Abstract

Background: Despite numerous published reports, there is no consensus in the literature as to whether the surgical repair of the pectus excavatum improves cardiovascular function. As a result, it has been suggested that correction should be considered a cosmetic procedure, and therefore, many health insurance companies have questioned whether the repair of the pectus excavatum improves cardiovascular function and thus are reluctant to authorize the procedure. The purpose of this study was to apply metaanalysis methodology to generate a quantitative synthesis of the effects of surgical repair on cardiovascular function and to test the hypothesis that surgical repair of the pectus excavatum results in significant improvements in cardiovascular function.

Methods: Studies were retrieved via computerized literature searches, cross-referencing from original and review articles, and a review of the reference list by a recognized authority in the area of pectus excavatum repair. The inclusion criteria were as follows: (1) reporting quantitative measures of preoperative and postoperative cardiovascular function; (2) published in the English language; (3) indexed between January 1960 and May 2005; (4) reporting the duration between which preoperative and postoperative assessments were conducted; and (5) describing the cardiovascular assessment procedures.

Results: A comprehensive search of the literature identified eight studies that met all of the inclusion criteria. These studies, representing 169 pectus excavatum patients, were used for the metaanalysis. Random-effects modeling yielded a mean weighted effect size (ES) for cardiovascular function that was statistically significant (ES, 0.59; 95% confidence interval, 0.25 to 0.92; p = 0.0006).

Conclusions: The findings of the present study indicated that surgical repair of the pectus excavatum significantly improves cardiovascular function and contradicts arguments that surgical repair is primarily cosmetic yielding minimal physiologic improvement.

Key Words: cardiac anatomy • cardiopulmonary function • chest wall deformity • oxygen uptake • physiology • surgery