# 75 Years of the Ravitch Procedure: A Historical Report and Review of Outcomes

## TL;DR

This paper reviews the 75-year history and outcomes of the Ravitch procedure for correcting pectus excavatum, showing it is now used more in adults and complex cases.

## Contribution

The paper provides a historical and outcome analysis of the Ravitch procedure, highlighting its current use in complex and adult cases.

## Key findings

- The Ravitch procedure is now performed more in adults and redo cases compared to its initial use in younger patients.
- Nuss repairs have shorter hospital stays compared to Ravitch procedures.
- The Ravitch procedure remains a safe option for complex chest wall deformities.

## Abstract

In 1949, Dr Mark Ravitch described an open surgical approach for correcting pectus excavatum with bilateral excision of the deformed costal cartilages followed by a transverse wedge osteotomy. In honor of the procedure’s 75th anniversary, this report reviews its development and patient outcomes at the Johns Hopkins Hospital (Baltimore, MD).

The Chesney Medical Archives and Epic databases were reviewed to identify patients who underwent surgical repair for pectus excavatum from 1947 to 2024. Patient and procedure characteristics were recorded. The Mark Ravitch and Alex Haller collections, which included personal notes and recordings of the procedure, were reviewed.

From the Johns Hopkins Hospital surgical logbooks (1947-1971), 217 open repair (Ravitch) operations were performed for pectus excavatum. The mean patient age was 7.0 (SD 6.8) years (range, 3 months to 42 years). 72.5% (n = 158) of patients were male, and 2.3% (n = 5) of cases were redo operations. From 2016 to 2024, 35 Ravitch and 271 Nuss repairs were performed. Patients who underwent Ravitch procedures were older (mean age, 36.0 [11.9]] years vs 15.8 [2.2] years; P < .0001) and included more redo operations (45.7% vs 1.5%; P < .0001). Nuss repairs were shorter in mean length of stay (2.4 [1.2] days vs 4.3 [2.0] days; P < .0001).

The Ravitch procedure is generally performed in adult patients rather than in the younger pediatric patients who underwent surgery at its introduction in 1949. This procedure is typically reserved for patients in whom conservative management with a Nuss procedure has failed. The Ravitch procedure has endured as a safe surgical approach with favorable outcomes for the surgical management of complex chest wall deformities.