{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:44:51Z","timestamp":1793295891201,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T00:00:00Z","timestamp":1627862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u2002<\/jats:title><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>To study the influence of sternal transection and costal chondrotomies on the stiffness and stresses in the rib cage of adult patients undergoing Nuss pectus excavatum procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Four pectus excavatum models with different Haller indexes were created by parameterizing a 3D model of a rib cage obtained based on a computed tomography scan of a patient with no pectus deformity. Using the finite element method, insertion of intrathoracic bars into all models was simulated in 3 conditions, namely, non-intervened, transverse sternal section and costal chondrotomies. Stiffness, stress distribution and maximum stresses for each case were obtained and compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Transverse sternotomy provided a reduction of 44% to 54% in the stiffness of the rib cage, depending on the Haller index analysed, while chondrotomies promoted a stiffness reduction of 70%. Stress distribution in the rib cage followed similar pattern for all the tested Haller index, but the maximum stress decreased by 36% when performing a transverse sternotomy, whereas when performing costal chondrotomies, it decreased by 47%.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Computational results report that transverse sternotomy reduces appreciably the stiffness of the rib cage, while costal chondrotomies promote even a higher stiffness reduction. Thus, these surgical procedures could improve the clinical outcomes of adult patients undergoing a pectus excavatum repair.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivab210","type":"journal-article","created":{"date-parts":[[2021,7,17]],"date-time":"2021-07-17T11:08:10Z","timestamp":1626520090000},"page":"99-104","source":"Crossref","is-referenced-by-count":3,"title":["Stiffness reduction of the rib cage to perform a minimally invasive pectus excavatum repair: biomechanical evaluation"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-2259","authenticated-orcid":false,"given":"\u00c1ngel Gabriel","family":"Vega-Artiles","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria , Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-5523","authenticated-orcid":false,"given":"Oscar","family":"Martel","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-781X","authenticated-orcid":false,"given":"Alberto","family":"Cuadrado","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1736-552X","authenticated-orcid":false,"given":"Alejandro","family":"Y\u00e1nez","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,2]]},"reference":[{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.admecli.2004.06.002","article-title":"Chest wall anomalies: pectus excavatum and pectus carinatum","volume":"15","author":"Goretsky","year":"2004","journal-title":"Adolesc Med Clin"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0022-3468(98)90314-1","article-title":"A 10-year review of a minimally invasive technique for the correction of pectus excavatum","volume":"33","author":"Nuss","year":"1998","journal-title":"J Pediatr Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/j.jtcvs.2007.08.013","article-title":"Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in different patterns between adult and child patients","volume":"134","author":"Nagasao","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jtcvs.2009.12.027","article-title":"Double-bar application decreases postoperative pain after the Nuss procedure","volume":"140","author":"Nagaso","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1053\/jpsu.2001.25791","article-title":"A simple technique for preventing bar displacement with the Nuss repair of pectus excavatum","volume":"36","author":"Hebra","year":"2001","journal-title":"J Pediatr Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.sempedsurg.2008.03.003","article-title":"Minimally invasive surgical repair of pectus excavatum","volume":"17","author":"Nuss","year":"2008","journal-title":"Semin Pediatr Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1590\/S1807-59322011001000012","article-title":"The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique","volume":"66","author":"Tedde","year":"2011","journal-title":"Clinics (Sao Paulo)"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ejcts.2009.03.061","article-title":"Technical modifications in stabilisers and in bar removal in the Nuss procedure","volume":"36","author":"Campos","year":"2009","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023032019563495900_","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/icvts\/ivz217","article-title":"Does the modelling of the pectus bar affect its stability? 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