Compressive bracing for pectus carinatum following congenital heart disease surgery in children: a retrospective cohort study

BACKGROUND: Pectus carinatum (PC) can develop as a secondary deformity following median sternotomy for congenital heart disease repair in children. While compressive bracing is an established first-line treatment for primary pectus carinatum, its safety and effectiveness in post-cardiac surgery patients remain uninvestigated. METHODS: A retrospective cohort study was conducted on 54 pediatric patients with PC secondary to congenital heart disease surgery, treated with custom-fitted compressive bracing at a single center (March 2019 to December 2020). The primary outcome was anteroposterior (AP) protrusion measurement at baseline, 3, 6, and 9 months. Satisfactory correction was defined as 50% or greater reduction in AP protrusion. Changes across time points were analyzed using the Friedman test with post-hoc Wilcoxon signed-rank tests. RESULTS: The cohort comprised 40 males and 14 females (median age 60.0 months). The median interval between cardiac surgery and bracing initiation was 36.0 months (IQR 24.0-54.0). Median AP protrusion decreased significantly from 12.2 cm at baseline to 6.8 cm at 9 months (Friedman test: p < 0.001). Satisfactory correction was achieved in 47 patients (87.0%). Adverse effects occurred in 7 patients (13.0%), were mild and self-limiting, with no cardiac complications. CONCLUSION: In this short-term follow-up study, compressive bracing appears to be a safe and effective non-operative approach for treating PC in pediatric patients following CHD surgery. These findings represent immediate outcomes and warrant confirmation in larger, controlled studies with longer follow-up.