Letter to the Editor Comment on: The Physiological Mirage: Why Oxygen Pulse Overstates Surgical Success in Pectus Excavatum

jpedsurg.org

We read with interest the correspondence by de Paoli et al. regarding the interpretation of oxygen pulse (VO2/HR) after minimally invasive repair of pectus excavatum (MIRPE).1 While the authors raise relevant methodological concerns, describing postoperative changes as a “physiological mirage” risks oversimplifying a complex physiological response.

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Article · May 2026 · 1 min read

In brief

This letter responds to methodological concerns about interpreting oxygen pulse (VO2/HR) as a measure of surgical success following minimally invasive pectus excavatum repair. The authors argue that dismissing postoperative changes as a 'physiological mirage' oversimplifies the complex cardiopulmonary adaptations after MIRPE.

Oxygen pulse (VO2/HR) interpretation after MIRPE requires careful consideration of underlying physiological mechanisms beyond simple calculation.
Describing postoperative VO2/HR changes as a 'physiological mirage' may oversimplify the complex cardiopulmonary adaptations following surgery.
Methodological rigor is essential when evaluating cardiopulmonary exercise testing outcomes in pectus excavatum surgical patients.
Clinical interpretation of oxygen pulse must account for multiple physiological variables, not just the mathematical ratio of VO2 to heart rate.
Critical appraisal of correspondence literature helps refine understanding of functional outcomes assessment in thoracic wall reconstruction.

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