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Vacuum bell treatment of pectus excavatum: An early North American experience

  • Etienne St-Louis
    Affiliations
    Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada

    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
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  • Jingru Miao
    Affiliations
    Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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  • Sherif Emil
    Affiliations
    Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada

    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
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  • Robert Baird
    Affiliations
    Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada

    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
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  • Marcos Bettolli
    Affiliations
    Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa
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  • Kathleen Montpetit
    Affiliations
    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
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  • Jade Goyette
    Affiliations
    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
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  • Jean-Martin Laberge
    Correspondence
    Corresponding author at: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Room B04.2078, Montreal, Quebec H4A 3J1. Tel.: +1 514 412 4498 (Office); fax: +1 514 412 4289.
    Affiliations
    Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada

    Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Quebec, Canada
    Search for articles by this author

      Abstract

      Purpose

      Conservative treatment of pectus excavatum with a vacuum bell device may be an attractive alternative to surgical repair. We describe an early North American experience with this device.

      Methods

      Prospectively maintained chest wall clinic registries from two institutions were reviewed to identify pectus excavatum patients ≤21 years treated with the vacuum bell from 2013 to 2017. Multivariate linear regression was used to compare mean improvements in deformity-depth and Haller Index between groups of patients based on age and usage metrics (hours/day and days/week).

      Results

      Thirty-one patients with a median age of 14 years received treatment with the device. Mean follow-up duration was 18 months. Median depth and Haller Index at treatment onset were 2.3 cm and 3.9, respectively. Improvements in deformity-depth were superior with device usage >2 h/day (p < 0.01) and daily use (p < 0.01). After adjusting for compliance, younger age of treatment onset was associated with greater improvement in Haller Index but not deformity depth.

      Conclusion

      Our prospective early North American experience found the vacuum bell to be a potential alternative to surgical treatment for pectus excavatum. Longer usage periods in a daily frequency are associated with best results.

      Type of study

      Treatment study; case series with no comparison group.

      Level of evidence

      Level IV.

      Key words

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