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Weight Gain Following Vertical Expandable Prosthetic Titanium Ribs Surgery in Children With Thoracic Insufficiency Syndrome

Skaggs, David L. MD; Sankar, Wudbhav N. MD; Albrektson, Josh MD; Wren, Tishya A. L. PhD; Campbell, Robert M. MD

doi: 10.1097/BRS.0b013e3181bd09f5

Study Design. Retrospective review of patients from a multicenter database.

Objective. To evaluate the nutritional status of children with thoracic insufficiency syndrome (TIS) and to determine if treatment with vertical expandable prosthetic titanium ribs (VEPTR) leads to improvements in weight percentile.

Summary of Background Data. Children with pulmonary insufficiency characteristically have poor nutrition as the energy expenditure from the extra work of breathing approaches the nutritional gain of eating. To our knowledge, no previous studies have examined the relation between VEPTR and potential nutritional improvements in children with TIS.

Methods. Seventy-six patients at 7 different institutions underwent placement of VEPTR devices for treatment or prevention of TIS. Mean age at surgery was 3.7 years (range, 8 months–14 years). All patients were observed for a minimum of 24 months with an average follow-up of 3.3 years (range, 2–6 years). Before surgery and at each postoperative visit, patients were weighed and the Cobb angle was measured. All weights were converted to normative percentiles based on the patient’s age.

Results. Overall, we found a significant increase in the percentile of patients’ weights after VEPTR surgery (P = 0.0004). Of the 76 patients in our series, 60 (79%) were ≤5 percentile in weight before surgery. Of these most nutritionally depleted patients, 40% (24/60) had increase in percentile weight after surgery; more subjects may have improved, but due to the basement effect ≤5 percentile any improvement in which the final weight was under 5 percentile may not have been detected. Of the 16 patients who were >5 percentile weight before surgery, 50% (8/16) had increased weight percentiles after surgery. For most patients, the majority of weight gain occurred between 4 and 8 months after surgery; weight gain continued up to 48 months after surgery. The change in Cobb angle had no relation to the change in weight percentile.

Conclusion. A total of 79% of patients with TIS were less than 5 percentile in weight, thus meeting the criteria for “failure to thrive.” Our study demonstrates a significant improvement in the nutritional status of these children after VEPTR surgery, which is an important outcome measure in this population.

Seventy-six patients were reviewed to evaluate the nutritional status of children with thoracic insufficiency syndrome and to determine the effect of vertical expandable prosthetic titanium ribs devices on weight percentile gain. Out study demonstrates that most patients with thoracic insufficiency syndrome are less than 5 percentile in weight, and that significant improvements in weight percentile occur after vertical expandable prosthetic titanium ribs surgery.

From the Children’s Hospital Los Angeles, Los Angeles, CA.

Acknowledgment date: March 12, 2008. Acceptance date: August 19, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This is an IRB approved study.

Address correspondence and reprint requests to David L. Skaggs, MD, Children’s Hospital Los Angeles, 4650 Sunset Boulevard #69, Los Angeles, CA 90027; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.