Change in Pulmonary Function after VEPTR Insertion

Introduction: The vertical expandible prosthetic titanium rib (VEPTR) has been inserted in children with thoracic insufficiency syndrome for the last decade to expand and support the chest and allow for further lung growth. Thought there is clincal and radiographic evidence demonstrating an expansion in the thorax, there is a paucity of data on the post-operative change in lung function after VEPTR insertion. Hypothesis: There will be a significant increase in lung function after VEPTR insertion and the earlier the insertion the greater the improvement.

Methods: The Chest Wall Disorders Study Group Database was queried and spirometry was available on 56 subjects and lung volume measurements on 12 subjects before and after VEPTR insertion at 7 different centers.

Results: There was no statistically significant change in FVC, FEV1, total lung capacity, or residual volume after VEPTR insertion by two-tailed t-test when measured at the first post-operative visit (7.7 ± 4.8 months). There was no difference relative to diagnosis or correlation between absolute change in pulmonary function and age.

Conclusion: There is no significant improvement in lung function after VEPTR surgery. Age has no impact on the change in pulmonary function after surgery.

Speculation: This lack of change in pulmonary function after VEPTR insertion may mean that the improvement may occur over a longer period of time, or that the benefit may instead be preservation of lung volume.