Patency of the internal mammary arteries after removal of the Nuss bar: an initial report

OBJECTIVES: Surgical correction of pectus excavatum (PE) has shifted to the modern minimally invasive Nuss procedure, which proved to be safe and effective. In order to restore the dented deformity, custom-curved metal bars provide continuous retrosternal pressure but cross the habitat of the internal mammary arteries (IMAs) directly affecting their patency. In this initial report, we sought to assess the patency of the IMAs in the first 6 patients who underwent Nuss bar removal in our department. METHODS: In 2010, we started to perform correction of PE using the Nuss bar technique. In 2013, observational analysis was performed on the first 6 patients who underwent removal of the Nuss bar. Computed tomography angiography (CTA) was performed in order to assess the patency of both IMAs directly after removal. RESULTS: In 4 (67%) patients, IMA patency was affected unilaterally (total obstruction or highly decreased flow pattern) corresponding with the lowest retrosternal side. CONCLUSIONS: According to our preliminary results, the oppressive force of Nuss bars interferes with IMA patency and thereby compromises future usability in coronary artery bypass grafting (CABG). We recommend that patients undergoing CABG following the Nuss procedure undergo preoperative evaluation of IMA patency. This study will be continued to include a larger number of patients including follow-up CTA one year after removal of the bar.