Short pectus bars with ventral hinge-point stabilization: clinical outcomes in 160 patients

Background ‘Minimally invasive repair of pectus excavatum’ (MIRPE) was introduced by Donald Nuss in 1998. Numerous modifications have since been proposed to minimize dislocation of the implanted bar(s). Progress was made by utilizing shorter bars, but the underlying biomechanics have remained somewhat unclear. At our center, we routinely use multiple short bars in modular/flexible (as opposed to closed/rigid) constructs with medial unilateral stabilizers, intended to provide freedom both laterally and between bars. Methods Having used MIRPE since 2001, we settled for the current approach in 2019. In most cases, we use two or three short bars in parallel, crossed, or “XI” configurations, the latter adding a third bar cranial to the cross. Each bar is inserted through the same retrosternal tunnel and fitted unilaterally with one ventral stabilizer near the thoracic entry point, coinciding with the hinge point of bar rotation. Given no bridging, or additional suturing for fixation, each of the bars in this retrospective series was mechanically independent. Results From 07/2019 to 02/2026, this approach was used in 160 consecutive patients. Median age was 16 (IQR: 14–20) years at the time of surgery. Revision due to clinically relevant bar migration was needed in 3 patients (1.88%). Two of these belonged to the minority of 41 adults (≥20 years by WHO criteria), one being a 15-year-old with challenging requirements. Stratified by age groups, the aforementioned rate would translate into 4.88% for adults and 0.84% for children/adolescents. No cases (0%) of bar ‘flipping’ have been observed (exact upper 95% confidence limit: 2.28%). Conclusions While fully acknowledging patient-based analysis as the standard, no bar flipping has been seen in 356 mechanically independent, short pectus bars with ventral hinge-point stabilization. Three bars had to be revised due to clinically relevant migration. Comparative studies are needed to determine any advantages that this biomechanical concept may hold over other stabilization strategies.