Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric Patients: A Prospective Pilot Study

Infographic · Jun 2025 · 1 min read

In brief

Prospective study of 25 pediatric patients demonstrates that minimally invasive pectus excavatum repair significantly improves O2 pulse (a stroke volume surrogate), suggesting relief of cardiac compression. While stroke volume improved post-operatively, overall exercise capacity showed variable results influenced by patient activity levels during bar placement.

MIRPE significantly increases O2 pulse (10.3 to 12.1 mL/beat), suggesting improved stroke volume and relief of cardiac compression.
Peak VO2/kg does not significantly improve post-MIRPE, indicating exercise capacity depends on factors beyond chest wall correction.
Patients with decreased activity levels at bar removal show reduced peak VO2/kg compared to pre-MIRPE baseline.
Cardiopulmonary benefits of MIRPE are multifactorial; stroke volume improves but overall exercise capacity may not change significantly.
CPET before MIRPE and after bar removal provides objective measures of cardiopulmonary function changes in pediatric pectus patients.

Written by the GCMD Library team from the infographic.

A clinical comparison chart displaying three treatment modalities arranged horizontally. Each section contains anatomical illustrations of the esophagus and lower esophageal sphincter, with color-coded success metrics and complication data presented in graphical format below each approach.

R Scott Eldredge, Arash Sabati, Brielle Ochoa, Vijay Viswanath, Emily Khoury, Kristin Rassam, Daniel J Ostlie, Justin Lee, Lisa McMahon, David M Notrica, Benjamin E Padilla

Introduction: The physiologic benefits of the minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function are poorly understood in pediatrics. We sought to examine the effects of MIRPE on exercise response during cardiopulmonary exercise testing (CPET).

Methods: A prospective-pilot study was conduct of patients ≤18 years who presented for pectus bar removal. All patients had CPET prior to MIRPE and following bar removal. Paired sample T tests were used to compare pre- and post-MIRPE CPET results.

Results: Twenty-five patients completed post-MIRPE CPET (72 % male, median age 18.6 [IQR:17.5-19.8]). The median Haller and correction indices were 4.5 and 29.4 %, respectively. There was significant increase in O2Pulse, (10.3 vs 12.1 mL/beat, p = 0.004), and percent predicted O2Pulse (79.5% vs 84.4 %, p = 0.046) following MIRPE/bar removal. The peak-VO2/kg and did not change significantly following MIRPE/bar removal; however, peak-VO2 (ml/min) increased. Patients with decreased activity levels at time of bar removal compared to pre-MIRPE had decreased peak-VO2/kg and predicted peak-VO2/kg.

Conclusion: Following MIRPE, patients experience increased in O2Pulse, which is a surrogate measure of stroke volume response to exercise and may reflect relief of cardiac compression. Cardiopulmonary function is multifactorial and despite improvement in stroke volume, other factors may impact exercise capacity (VO2) following MIRPE.

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