Treatment of pectus excavatum in children with the vacuum bell: a literature review

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Abstract

Pectus excavatum is the most common type of chest deformation with the sunken sternum and adjacent parts of the ribs. In recent decades, approach to the management of this pathology has changed, in many respects due to Eckhart Kloba’s invention a vacuum bell in 1992, which can be used both intraoperatively and as a non-invasive monotherapy.

Literary sources were searched in PubMed, Web of Science, Scopus, Google Scholar, and Elibrary databases. The following keywords were used for search in the English literature: «pectus excavatum», «funnel chest», «vacuum bell», «vacuum chest wall lifter», «suction cup», «minimally invasive repair of pectus excavatum (MIRPE)», «intraoperative vacuum bell». In Russian-language literature sources, the key words were: “воронкообразная деформация грудной клетки», «консервативное лечение», «вакуумный колокол». More than 50 publications on this topic have been analyzed.

Patients of different age groups with pectus excavatum of varying severity were taken in the study. The effectiveness of treatment was mainly assessed by computed tomography measurements of deformity depth and the Haller index before and after treatment. Excellent correction results were achieved in 13.5–80% of patients with the vacuum bell. The authors have made an attempt to define how patient’s age, duration of treatment, pathology severity, and deformity type correlate with the effectiveness of vacuum bell treatment. The vacuum bell can also be used as a non-invasive lift of the sternum during Nuss thoracoplasty surgery.

Currently, there is no any unified tactics for the conservative management of patients with pectus excavatum, namely, unified indications, period of conservative treatment, and optimal patient’s age for vacuum bell application. In the available literature, there is no any criterion that could predict the success of conservative treatment; there are no follow-up data for more than 2 years. A more precise assessment of vacuum bell effectiveness in the treatment of patients with pectus excavatum should be confirmed in longer studies with a larger number of cases.

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About the authors

Alena O. Shominova

The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: alshominova@icloud.com
ORCID iD: 0000-0001-7205-0937
Россия, 1 Ostrovityanova street, 117887 Moscow

Zorikto B. Mitupov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children’s City Hospital

Email: zmitupov@mail.ru
ORCID iD: 0000-0002-0016-6444
SPIN-code: 5182-1748

MD, Dr. Sci. (Medicine), Professor

Россия, 1 Ostrovityanova street, 117887 Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow; Moscow

Aleksander Yu. Razumovskij

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children’s City Hospital

Email: 1595105@mail.ru
ORCID iD: 0000-0002-9497-4070
SPIN-code: 3600-4701

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Россия, 1 Ostrovityanova street, 117887 Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow; Moscow

Vera I. Nurik

The Russian National Research Medical University named after N.I. Pirogov

Email: vera.nurik@mail.ru
ORCID iD: 0009-0002-6025-1357
SPIN-code: 1431-2990

MD, Cand. Sci. (Medicine)

Россия, 1 Ostrovityanova street, 117887 Moscow

George S. Gincu

Nicolae Testemicanu State Medical and Pharmaceutical University

Email: laritei@mail.ru
ORCID iD: 0000-0003-4350-5423

MD, Dr. Sci. (Medicine)

Россия, Chisinau

Anatoliy A. Pavlov

Republican Children`s Clinical Hospital

Email: doctorpavlov@mail.ru
ORCID iD: 0000-0003-1709-646X

MD, Cand. Sci. (Medicine)

Россия, Cheboksary

References

  1. Alkhasov AB, Batrakov SYu. Funnel-shaped deformity of the thorax. In: Razumovsky AYu editor. Paediatric surgery: National guide. 2nd ed. Series "National Guidelines". Moscow: GEOTARMedia; 2021. Р:86–91. (In Russ.) doi: 10.33029/9704-5785-6-PSNR-2021-2-1-1280
  2. Kulik IO, Plyakin VA, Sarukhanyan OO. Etiology and pathogenesis of pectus excavatum in children. Traumatology and orthopedics of Russia. 2013;(2):136–141. EDN: QJEVKJ
  3. Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic char-acteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;21(1):44–57. EDN: XWYVFI doi: 10.1053/j.semtcvs.2009.03.001
  4. Saxena AK. Overview of repair of pectus excavatum type of deformities. In book: Chest wall deformities. Berlin: Springer; 2017. P.329–349. doi: 10.1007/978-3-662-53088-7_27
  5. Lopushinsky SR, Fecteau AH. Pectus deformities: A review of open surgery in the modern era. Semin Pediatr Surg. 200;17(3):201–208. doi: 10.1053/j.sempedsurg.2008.03.009
  6. Kelly AM, Frauenfelder T, Hodler J, et al. Diseases of the chest wall, pleura, and diaphragm. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the chest, breast, heart and vessels 2019–2022: Diagnostic and interventional imaging [Internet]. Cham (CH): Springer; 2019. Chapter 9. Р:95–106. doi: 10.1007/978-3-030-11149-6_9
  7. Komolkin IA, Afanasyev AP, Shchegolev DV. The role of heredity in the occurrence of the chest congenital deformities (review of the literature). Genij ortopedii. 2012;(2):152–156. EDN: PBXKJB
  8. Baran S, Ignyś A, Ignyś I. Respiratory dysfunction in patients with Marfan syndrome. J Physiol Pharmacol. 2007;58(Suppl 5, Pt 1):37–41.
  9. Kelly RE. Pectus excavatum: Historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg. 2008;17(3):181–193. doi: 10.1053/j.sempedsurg.2008.03.002
  10. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–1081. doi: 10.1097/SLA.0b013e3181effdce
  11. Robicsek F, Watts LT. Surgical correction of pectus excavatum. How did we get here? Where are we going? Thorac Cardiovasc Surg. 2011;59(1):5–14. doi: 10.1055/s-0030-1250602
  12. Goretsky MJ, Kelly RE, Croitoru D, Nuss D. Chest wall anomalies: Pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15(3):455–471. doi: 10.1016/j.admecli.2004.06.002
  13. Park HJ, Lee IS, Kim KT. Extreme eccentric canal type pectus excavatum: Morphological study and repair techniques. Eur J Cardiothorac Surg. 2008;34(1):150–154. doi: 10.1016/j.ejcts.2008.03.044
  14. Loufopoulos I, Karagiannidis IG, Lampridis S, et al. Vacuum bell: Is it a useful innovative device for pectus excavatum correction? Turk Thorac J. 2021;22(3):251–256. doi: 10.5152/TurkThoracJ.2021.20035
  15. Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum: A review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230–239. doi: 10.3122/jabfm.2010.02.090234
  16. Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: The basle ex-perience. Pediatr Surg Int. 2011;27(6):623–627. EDN: KFRHMI doi: 10.1007/s00383-010-2843-7
  17. Haecker FM, Sesia S. Non-surgical treatment of pectus excavatum. J Vis Surg. 2016;23(2):63. doi: 10.21037/jovs.2016.03.14
  18. Haecker FM, Sesia S. Vacuum bell therapy. Ann Cardiothorac Surg. 2016;5(5):440–449. doi: 10.21037/acs.2016.06.06
  19. Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: An innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg. 2005;40(3):496–500. doi: 10.1016/j.jpedsurg.2004.11.033
  20. Obermeyer RJ, Cohen NS, Kelly RE, et al. Nonoperative management of pectus excavatum with vacuum bell therapy: A single center study. J Pediatr Surg. 2018;53(6):1221–1225. doi: 10.1016/j.jpedsurg.2018.02.088
  21. Lopez M, Patoir A, Costes F, et al. Preliminary study of efficacy of cup suction in the correc-tion of typical pectus excavatum. J Pediatr Surg. 2016;51(1):183–187. doi: 10.1016/j.jpedsurg.2015.10.003
  22. St-Louis E, Miao J, Emil S, et al. Vacuum bell treatment of pectus excavatum: An early North American experience. J Pediatr Surg. 2019;54(1):194–199. doi: 10.1016/j.jpedsurg.2018.10.011
  23. Toselli L, Vallee M, Elmo G, et al. Implementation and acceptance rates of a specially de-signed vacuometer for the vacuum bell treatment of pectus excavatum. J Pediatr Surg. 2021;56(12):2235–2238. doi: 10.1016/j.jpedsurg.2021.03.008
  24. Jung Y, Yi E, Lee K, et al. Surgical versus vacuum bell therapy for the correction of pectus excavatum: A comparison of 1-year treatment outcomes. J Chest Surg. 2021;54(6):473–479. doi: 10.5090/jcs.21.073
  25. Togoro SY, Tedde ML, Eisinger RS, et al. The vacuum bell device as a sternal lifter: An im-mediate effect even with a short time use. J Pediatr Surg. 2018;53(3):406–410. doi: 10.1016/j.jpedsurg.2017.04.016
  26. Yi E, Lee K, Jung Y, et al. Finding suitable candidates for vacuum bell therapy in pectus ex-cavatum patients. Sci Rep. 2021;11(1):22787. doi: 10.1038/s41598-021-02250-x
  27. Mertens LL, Friedberg MK. Imaging the right ventricle--current state of the art. Nat Rev Cardi-ol. 2010;7(10):551–563. doi: 10.1038/nrcardio.2010.118
  28. Monti L, Montini O, Voulaz E, et al. Cardiovascular magnetic resonance assessment of biven-tricular changes during vacuum bell correction of pectus excavatum. J Thorac Dis. 2019;11(12):5398–5406. doi: 10.21037/jtd.2019.12.41
  29. Deng X, Huang P, Luo J, et al. A novel three-dimensional printed vacuum bell for pectus ex-cavatum treatment: A preliminary study. J Cardiothorac Surg. 2020;15(1):240. doi: 10.1186/s13019-020-01276-y
  30. Patel AJ, Hunt I. Is vacuum bell therapy effective in the correction of pectus excavatum? In-teract Cardiovasc Thorac Surg. 2019;29(2):287–290. doi: 10.1093/icvts/ivz082
  31. Sesia SB, Hradetzky D, Haecker FM. Monitoring the effectiveness of the vacuum bell during pectus excavatum treatment: Technical innovation. J Pediatr Surg. 2018;53(3):411–417. doi: 10.1016/j.jpedsurg.2017.05.023
  32. Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg. 2016;5(5):493–500. doi: 10.21037/acs.2016.06.04
  33. Gao Y, Li JH, Yu JG, et al. Noninvasive treatment of pectus excavatum with a vacuum bell combined with a three-dimensional scanner. Pediatr Surg Int. 2020;36(10):1205–1211. doi: 10.1007/s00383-020-04726-9
  34. Shi Z, Li J, Gao Y, et al. Application of cameral-type three-dimensional scan in assessment of funnel chest. (In Chinese). Zhejiang Da Xue Xue Bao Yi Xue Ban. 2018;47(3):289–293. doi: 10.3785/j.issn.1008-9292.2018.06.12
  35. Deng X, Huang P, Luo J, et al. A novel three-dimensional printed vacuum bell for pectus ex-cavatum treatment: A preliminary study. J Cardiothorac Surg. 2020;15(1):240. doi: 10.1186/s13019-020-01276-y
  36. Furuta S, Nagae H, Ohyama K, et al. The vacuum treatment for the pectus excavatum thickened subcutaneous fat of the chest wall and is effective in preteenagers. Pediatr Surg Int. 2020;36(12):1465–1469. doi: 10.1007/s00383-020-04758-1
  37. Amăricăi E, Suciu O, Onofrei RR, et al Assessment of children with pectus excavatum with-out surgical correction. Wien Klin Wochenschr. 2019;131(5-6):126–131. doi: 10.1007/s00508-018-1406-0
  38. Kuhn MA, Nuss D. Pectus deformities. In: Mattei P, editor. Fundamentals of pediatric surgery. New York: Springer; 2011. Р:313–321.
  39. Schwabegger AH, Kuhn AM, Nuss D. Special techniques in the funnel chest deformity. In: Schwabegger AH, editor. Congenital thoracic wall deformities: Diagnosis, therapy and current developments. Vienna: Springer; 2011. Р:107–200.
  40. Cheung SY. Exercise therapy in the correction of pectus excavatum. J Pediatr Respir Crit Care. 2005;(1):10–13.
  41. Kelly RE, Shamberger RC. Congenital chest wall deformities. In: Coran AG, Caldamone A, Adzick NS, et al., editors. Pediatric surgery. 7th ed. Amsterdam: Elsevier Saunders; 2012. Р:779–796.
  42. Rebeis EB, Campos JR, Fernandez A, et al. Anthropometric index for Pectus excavatum. Clin-ics (Sao Paulo). 2007;62(5):599–606. doi: 10.1590/s1807-59322007000500011
  43. Norlander L, Karlsson J, Anderzén-Carlsson AV,et al. Translation and psychometric evalua-tion of the Swedish versions of the nuss questionnaire modified for adults and the single step questionnaire. J Patient Rep Outcomes. 2021;5(1):21. doi: 10.1186/s41687-021-00293-2
  44. Bahadir AT, Kuru P, Afacan C, et al. Validity and reliability of the Turkish version of the nuss questionnaire modified for adults. Korean J Thorac Cardiovasc Surg. 2015;48(2):112–119. doi: 10.5090/kjtcs.2015.48.2.112
  45. Alaca N, Alaca I, Yüksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interact Cardiovasc Thorac Surg. 2020;31(5):650–656. doi: 10.1093/icvts/ivaa161
  46. Toselli L, Chinni E, Nazar-Peirano M, et al. Determinants of success associated with vacuum bell treatment of pectus excavatum. J Pediatr Surg. 2022;57(11):550–554. doi: 10.1016/j.jpedsurg.2022.04.010
  47. Croitoru DP, Kelly RE, Goretsky MJ, et al. Experience and modification update for the mini-mally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002;37(3):437–445. doi: 10.1053/jpsu.2002.30851
  48. Zou J, Luo C, Liu Z, Cheng C. Cardiac arrest without physical cardiac injury during Nuss re-pair of pectus excavatum. J Cardiothorac Surg. 2017;12(1):61. doi: 10.1186/s13019-017-0624-2
  49. Becmeur F, Ferreira CG, Haecker FM, et al. Pectus excavatum repair according to Nuss: Is it safe to place a retrosternal bar by a transpleural approach, under thoracoscopic vision? J Laparoendosc Adv Surg Tech A. 2011;21(8):757–761. doi: 10.1089/lap.2011.0035
  50. Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA. Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum. Semin Pediatr Surg. 2009;18(2):66–72. doi: 10.1053/j.sempedsurg.2009.02.002
  51. Hebra A. Minor and major complications related to minimally invasive repair of pectus exca-vatum. Eur J Pediatr Surg. 2018;28(4):320–326. doi: 10.1055/s-0038-1670690
  52. Haecker FM, Sesia SB. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A. 2012;22(9):934–936. doi: 10.1089/lap.2012.0030
  53. Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally in-vasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg. 2019;29(4):497–502. doi: 10.1093/icvts/ivz142
  54. Elsayed H. Crane technique with the vacuum bell device for improving access in the Nuss procedure. J Thorac Cardiovasc Surg. 2015;150(5):1372–1373. doi: 10.1016/j.jtcvs.2015.03.064

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