V. Pulivarthi1, R. Arsanjani1, A. Gotimukul1, M. Gotway1, E. Calderon1, D. Jaroszewski1 1Mayo Clinic In Arizona,Cardiothoracic Surgery,Phoenix, AZ, USA
Introduction:
Pectus excavatum deformity (PE) is reported to be more common in males, but objective measures by gender have not been studied. We evaluated gender differences in PE severity, exercise capacity and stroke volume by cardiopulmonary exercise test (CPET) and echocardiography in adult patients undergoing PE repair at a single institution.
Methods:
A retrospective chart review was performed of 772 adult patients (≥18 years) undergoing PE repair from Jan 2010 to July 2019. Patients who had secondary repair at our institute after outside procedures and those with mixed PE deformities including carinatum and arcuatum were excluded. Severity of PE was assessed with Haller index (HI) as measured by computerized tomography or magnetic resonance imaging. Baseline demographic information, symptoms and history were reviewed; breathing reserve (BR%), peak oxygen uptake (VO2 max) and stroke volume (in terms of O2/pulse) on cardiopulmonary exercise test were assessed. Right ventricular outflow tract, velocity time integral (RVOT VTI) on transthoracic echocardiogram was used as an indirect measure of stroke volume. Two sample t-test for means and chi-square test for proportions were performed to compare male versus female coharts.
Results:
In total,577 patients met study inclusion criteria with 70% being males. Table 1 summarizes outcomes. Severity of PE was significantly greater in the female cohort (p<0.000001) as was an extremely severe PE as indicated by HI >5 (p<0.0001). In females, cardiopulmonary exercise testing was significantly lower; including peak exercise BR%, VO2max, and O2/pulse during peak stress. Stroke volume, both supine and sitting, was also lower in the female cohort (p=0.002; p=0.02) Female patients additionally reported more symptoms.
Conclusion:
Adult females with pectus excavatum presenting for surgical correction had higher symptom burden, lower exercise capacity/stroke volume and greater severity of PE compared to males.
