Prospective Evaluation of Cardiovascular, Pulmonary, and Biochemical Changes Following Minimally Invasive Repair of Pectus Excavatum in Children: Study Protocol.

BACKGROUND: Pectus excavatum is the most common congenital chest wall deformity and it may impair cardiovascular function, pulmonary mechanics, exercise capacity, and quality of life. Although minimally invasive repair of pectus excavatum (MIRPE) is the current standard surgical treatment, the perioperative dynamics of myocardial injury, inflammation, and their relationship with functional and echocardiographic changes remain incompletely understood, particularly in pediatric patients. OBJECTIVE: The objective is to prospectively evaluate the perioperative dynamics of cardiac troponin and the change in right ventricular free-wall longitudinal strain as co-primary endpoints, and-as secondary outcomes-additional biochemical markers, echocardiographic parameters, pulmonary function, exercise capacity, and quality of life in children and adolescents undergoing MIRPE. METHODS: This is a single-center, prospective, observational cohort study to be conducted at the Department of Pediatric Surgery and Urology, University Children's Clinical Hospital, Medical University of Bialystok, Poland. Sixty pediatric patients (approximately 14-18 years of age) undergoing primary minimally invasive repair of pectus excavatum will be enrolled. Biochemical markers, including troponins, natriuretic peptides and inflammatory markers will be assessed before surgery and during the first 72 h postoperatively. Echocardiography, pulmonary function tests (spirometry and body plethysmography), the 20 m shuttle run test (Léger), and quality-of-life assessments will be performed preoperatively and during postoperative follow-up. Longitudinal changes will be analyzed using appropriate statistical methods for repeated measurements. DISCUSSION: This study is expected to provide a comprehensive evaluation of the cardiovascular, pulmonary, biochemical, and functional consequences of minimally invasive repair of pectus excavatum in pediatric patients. The findings may improve the understanding of the perioperative myocardial response, cardiac remodeling, and functional recovery following the MIRPE and contribute to optimizing perioperative assessment and long-term follow-up in this patient population.