Exercise Testing Outcomes After Pectus Excavatum Repair: A 16-Year Experience

Objective To evaluate changes in cardiopulmonary exercise testing (CPET) performance after minimally invasive repair of pectus excavatum (PE) in adults and to identify factors associated with postoperative functional improvement. Methods Retrospective single-center cohort study including patients who underwent primary PE repair with preoperative CPET between January 2010 and January 2026. Patients with major comorbidities or concomitant cardiac surgery were excluded. Among 1443 patients, 846 had preoperative CPET; 488 (57.7%) underwent bar removal, and 326 (66.8%) completed paired postoperative CPET before removal. Changes in CPET parameters were analyzed using paired comparisons. Multivariable logistic regression identified predictors of >10% improvement in percent predicted peak oxygen uptake (VO 2 ). Results Among 326 patients with paired CPET, mean (SD) time to postoperative testing was 45.8 (16.1) months. At baseline, 228 (70.0%) had reduced percent predicted peak VO 2 (<80%), and 134 (41.0%) had reduced oxygen pulse. Significant improvements were observed across all CPET parameters after repair (all P<0.05). Most patients reported improvement in symptoms (96.7%) and exercise capacity (86.4%). No significant interaction was observed between subjective improvement and change in percent predicted peak VO 2 (P for interaction >0.80). On multivariable analysis, higher correction index independently predicted >10% improvement in percent predicted peak VO 2 (OR 1.04; 95% CI, 1.00–1.08; P=.032), whereas age, sex, body mass index, Haller index, and number of bars were not associated. Conclusions Minimally invasive repair of PE in adults is associated with significant improvement in objective exercise capacity. Functional gains occur independently of symptom perception, while greater anatomical severity predicts larger improvement.