Sternal advancement surgery for pectus excavatum: a systematic review and meta-analysis of cardiac and respiratory function outcomes

Pectus excavatum (PE) is the most common malformation of the anterior chest wall, affecting around 1 in 400 births, with a male/female sex ratio of 5:1. Even if the functional repercussions and management of PE are still the subject of many debates, the cardiorespiratory function improvement after surgical correction of PE with sternal advancement seem to be confirmed in the recent literature. This study aims to assess the impact of sternal advancement surgery-specifically minimally invasive repair of PE (MIRPE) and sternochondroplasty-on cardiorespiratory function at rest and during exercise in patients with PE. A meta-analysis was conducted on 21 studies reporting pre- and post-operative cardiac and/or respiratory function at rest and during exercise. A total of 1,087 patients (mean age, 18.93 years) were included. Significant improvements were found in resting cardiac function, including cardiac output (P=0.04), cardiac index (P=0.03), left ventricular systolic ejection volume (LVSEV, P=0.001), and ejection fraction (P=0.03). Exercise capacity also improved significantly, with increases in VO2max and O2 pulse (both P<0.001). No significant changes were observed in respiratory parameters. Cardiac output assessment should be central to surgical decision-making in PE. Techniques involving sternal mobilization can yield meaningful improvements in cardiopulmonary function, unlike procedures that do not remodel the osteocartilaginous deformity.