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The following is a summary of “Cardiopulmonary impact of the minimally invasive repair of pectus excavatum in pediatric patients: A prospective pilot study,” published in the January 2025 issue of Pediatrics by Eldredge et al.

The physiological effects of minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function in pediatric patients remain poorly understood. This prospective pilot study aimed to evaluate the impact of MIRPE on exercise response through cardiopulmonary exercise testing (CPET). The study included patients aged ≤18 years undergoing MIRPE and subsequent pectus bar removal. Each participant underwent CPET before MIRPE and after bar removal, with paired sample t-tests used to compare pre-and post-MIRPE CPET outcomes.

A total of 25 patients (72% male, median age 18.6 years [IQR: 17.5–19.8]) completed post-MIRPE CPET. The median Haller index and correction index were 4.5 and 29.4%, respectively. Significant improvements were observed in O₂Pulse, a surrogate marker of stroke volume response to exercise, which increased from 10.3 ml/beat pre-MIRPE to 12.1 ml/beat post-MIRPE (p=0.004). Similarly, percent-predicted O₂ Pulse increased from 79.5% to 84.4% (p=0.046). Although peak VO₂/kg did not show a significant change, peak VO_2. (ml/min) increased following MIRPE. Notably, patients who reported reduced physical activity at the time of bar removal compared to pre-MIRPE demonstrated declines in both peak VO₂/kg and percent-predicted peak VO₂/kg.

These findings suggest that MIRPE results in improved stroke volume response to exercise, as reflected by increased O₂ Pulse, which may indicate alleviation of cardiac compression caused by pectus excavatum. However, overall exercise capacity, as measured by peak VO₂, is influenced by multiple factors, including physical activity levels, which may partially offset the benefits of improved stroke volume. This study highlights the complex interplay of physiological adaptations following MIRPE and underscores the need for a multifactorial approach when evaluating postoperative exercise capacity in pediatric patients. Further research is warranted to better understand the determinants of cardiopulmonary function and optimize outcomes for this population.

Source: sciencedirect.com/science/article/abs/pii/S0022346825000223