A new study suggests that using a vacuum bell during the Nuss procedure may be an effective way to lift the chest to help prevent cardiac perforation.
The Nuss procedure for Pectus excavatum is becoming increasingly popular as a safe and effective alternative to the mostly outdated Ravitch procedure. A major risk in the Nuss procedure is cardiac perforation with either the introducer or a pectus bar. The introducer is used to tunnel along the chest wall from side to side to create a path to place the nuss bar.
There are several techniques to minimize cardiac injury during the surgery. Many institutions prefer to physically lift the sternum during this step to create a larger space between the chest wall and the heart to tunnel through. This is commonly done in an invasive manner using a pulley to physically crank the sternum up.
In a recent study, authors review the use of the vacuum bell to lift the chest temporarily during surgery instead. Several preliminary reports tested whether the vacuum bell could effectively lift the chest with just a short-term application. In this paper, in a series of 131 patients that this was tested on, it was shown to be effective and the only side effect observed was mild hematoma.
If you’re getting the Nuss procedure, be sure to ask your surgeon which technique they are using to prevent cardiac perforation during tunneling. The pulley approach is invasive and may leave additional scars (albeit small) around the center of the chest.