Magnetic Mini-Mover Procedure to Treat Pectus Excavatum
NCT ID: NCT00466206
Last Updated: 2016-01-01
Study Results
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View full resultsBasic Information
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COMPLETED
PHASE1/PHASE2
10 participants
INTERVENTIONAL
2007-04-30
2011-04-30
Brief Summary
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The study investigators have developed a method to gradually repair pectus excavatum (sunken chest) deformity by placing a magnet on the sternum (breastbone) and then applying an external magnetic force that will pull the sternum outward gradually.
Potential candidates for this study are children and adolescents with a previously diagnosed congenital pectus excavatum (sunken chest) deformity who are otherwise healthy and are seeking corrective surgery for their condition. They will be residents of the U.S. and between the ages of 8 and 14 years of age. Potential candidates and their families will have already been counseled about this condition and about the standard way to repair this deformity.
The purpose of this study is to test what effects, good and/or bad, placing an external/internal magnetic device has on correcting pectus excavatum deformity in children, and the safety of using such a device for treatment.
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Detailed Description
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The hypothesis of this study is that constant outward force on the deformed cartilage in pectus excavatum will produce biologic reformation of cartilage and correction of the chest wall deformity.
The study investigators have developed a novel method of achieving gradual deformation/reformation of chest wall cartilage without the need for transdermal orthopedic devices or repeated surgeries. A magnetic force field is used to apply controlled, sustained force to promote biologic reformation of structural cartilage (the same principle as distraction osteogenesis). A magnet is implanted on the sternum and secured using a novel fixation strategy that can be accomplished through a 3-cm subxyphoid incision as a brief outpatient procedure. The magnet (and sternum) is pulled outward by another magnet suspended in a novel, low-profile, lightweight device previously molded to the patient's anterior chest wall. The external magnet allows individual adjustment in small increments of the distance (and, thus, force) and orientation of the force applied to the sternum. The low-profile, non-obtrusive anterior chest wall prosthesis is held in place by the force field between the two magnets.
The study objectives are to test the safety and probable benefit of this procedure in 10 otherwise healthy, young patients, between 8 years and 14 years of age, who have chosen to have this deformity corrected using this novel technique rather than the standard Ravitch or Nuss techniques. We will document the rate of correction by chest imaging and measurement of the Pectus Severity Index. The study investigators will document safety and efficacy with an EKG prior to implantation, one month post-implantation, and finally after the magnet is removed, as well as patient and family satisfaction with a post-procedure Quality of Life-type survey.
Conditions
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Study Design
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NA
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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3MP - Treatment Arm
Magnetic Mini-Mover Procedure using the Magnimplant and Magnatract
Magnetic Mini-Mover Procedure (3MP)
A rare earth magnet encased in FDA-approved titanium will be implanted securely on the outer surface of the lower end of the sternum in patients with pectus excavatum. This is accomplished as an outpatient procedure, under brief general anesthesia.
A 2-inch transverse skinline incision is made at the junction of the sternum and xyphoid and the space in front and behind the sternum is dissected bluntly. The titanium can containing the magnet is securely fixed to the sternum by screwing it into a titanium fixation disk in front of the sternum. The procedure takes 1/2-hour, and the patient can go home the same day.
In another outpatient procedure, the Magnimplant is explanted 18 months after implantation.
Magnatract (external magnet in a removable external brace)
An external orthotic device "Magnatract" which includes an external magnet in a removable brace is fitted specifically to the patient's chest wall deformity. A calibrated meter in the external device measures the force applied between the two magnets. When the patient and family are comfortable with the device and comfort and skin condition have been assessed, the patient will be allowed to take the Magnatract home and begin the process of gradually advancing the sternum forward as the abnormal costal cartilage is reformed.
3MP (Magnetic Mini-Mover Procedure)
* Subject has EKG performed to measure baseline cardiac activity.
* Magnimplant is implanted.
* After one week, "Magnatract" is fitted.
* Chest x-ray and 2nd EKG performed 30 days post-implantation.
* Patient and parents complete QoL questionnaire 30d post-implantation.
* Patient seen weekly for first month post-implantation to assess comfort and skin condition. Thereafter, will be seen monthly.
* At each monthly visit, patient will have lateral and anterior-posterior chest X-rays to monitor sternal correction.
* At each visit data logger is downloaded to measure strength of pull since last visit and amount of wear-time.
* Magnimplant explanted 18 months later as 1/2-hr outpatient procedure.
* CT scan and third EKG performed after explanation.
* Patient and parents complete QOL questionnaires after explantation and 1 yr post-explantation.
Interventions
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Magnetic Mini-Mover Procedure (3MP)
A rare earth magnet encased in FDA-approved titanium will be implanted securely on the outer surface of the lower end of the sternum in patients with pectus excavatum. This is accomplished as an outpatient procedure, under brief general anesthesia.
A 2-inch transverse skinline incision is made at the junction of the sternum and xyphoid and the space in front and behind the sternum is dissected bluntly. The titanium can containing the magnet is securely fixed to the sternum by screwing it into a titanium fixation disk in front of the sternum. The procedure takes 1/2-hour, and the patient can go home the same day.
In another outpatient procedure, the Magnimplant is explanted 18 months after implantation.
Magnatract (external magnet in a removable external brace)
An external orthotic device "Magnatract" which includes an external magnet in a removable brace is fitted specifically to the patient's chest wall deformity. A calibrated meter in the external device measures the force applied between the two magnets. When the patient and family are comfortable with the device and comfort and skin condition have been assessed, the patient will be allowed to take the Magnatract home and begin the process of gradually advancing the sternum forward as the abnormal costal cartilage is reformed.
3MP (Magnetic Mini-Mover Procedure)
* Subject has EKG performed to measure baseline cardiac activity.
* Magnimplant is implanted.
* After one week, "Magnatract" is fitted.
* Chest x-ray and 2nd EKG performed 30 days post-implantation.
* Patient and parents complete QoL questionnaire 30d post-implantation.
* Patient seen weekly for first month post-implantation to assess comfort and skin condition. Thereafter, will be seen monthly.
* At each monthly visit, patient will have lateral and anterior-posterior chest X-rays to monitor sternal correction.
* At each visit data logger is downloaded to measure strength of pull since last visit and amount of wear-time.
* Magnimplant explanted 18 months later as 1/2-hr outpatient procedure.
* CT scan and third EKG performed after explanation.
* Patient and parents complete QOL questionnaires after explantation and 1 yr post-explantation.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
2. Otherwise healthy male or female with pectus excavatum deformity;
3. Between 8 and 14 years of age;
4. Pectus Severity Index \> 3.5 (normal 2.56); and
5. Ability to read and speak English.
Exclusion Criteria
2. Bleeding disorders;
3. Heart disease (including arrhythmia);
4. Persons with active implantable medical devices (AIMD) such as pacemakers;
5. Persons with a relative(s) or close family friend(s) living within their households and having a pacemaker;
6. Persons with arteriovenous malformations;
7. Chest deformity more complicated than pectus excavatum (e.g.. Poland syndrome);
8. Persons for whom a foreign body implant would pose a risk (e.g., immunodeficiency);
9. Persons at increased risk for general anesthesia (e.g., history of malignant hyperthermia);
10. Respiratory conditions that have required steroid treatment (e.g., prednisone)in the last 3 years;
11. Pregnancy;
12. Inability to understand or follow instructions;
13. Refusal to wear the external brace;
14. Inability to obtain pre-approval (authorization) from the patient's insurance carrier; and
15. Inability or refusal to return to UCSF for weekly follow-up visits for the first month after surgery.
8 Years
14 Years
ALL
Yes
Sponsors
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FDA Office of Orphan Products Development
FED
University of California, San Francisco
OTHER
Responsible Party
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Michael Harrison
Professor of Surgery and Pediatrics, Emeritus
Principal Investigators
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Michael R Harrison, MD
Role: PRINCIPAL_INVESTIGATOR
University of California, San Francisco Medical Center and Children's Hospital
Locations
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University of California, San Francisco
San Francisco, California, United States
Countries
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References
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RAVITCH MM. The operative treatment of pectus excavatum. J Pediatr. 1956 Apr;48(4):465-72. doi: 10.1016/s0022-3476(56)80075-9. No abstract available.
WELCH KJ. Satisfactory surgical correction of pectus excavatum deformity in childhood; a limited opportunity. J Thorac Surg. 1958 Nov;36(5):697-713. No abstract available.
Morshuis WJ, Mulder H, Wapperom G, Folgering HT, Assman M, Cox AL, van Lier HJ, Vincent JG, Lacquet LK. Pectus excavatum. A clinical study with long-term postoperative follow-up. Eur J Cardiothorac Surg. 1992;6(6):318-28; discussion 328-9. doi: 10.1016/1010-7940(92)90149-r.
ADKINS PC, BLADES B. A stainless steel strut for correction of pectus escavatum. Surg Gynecol Obstet. 1961 Jul;113:111-3. No abstract available.
Shamberger RC. Congenital chest wall deformities. Curr Probl Surg. 1996 Jun;33(6):469-542. doi: 10.1016/s0011-3840(96)80005-0. No abstract available.
Nuss D, Croitoru DP, Kelly RE Jr, Goretsky MJ, Nuss KJ, Gustin TS. Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg. 2002 Aug;12(4):230-4. doi: 10.1055/s-2002-34485.
Beiser GD, Epstein SE, Stampfer M, Goldstein RE, Noland SP, Levitsky S. Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. N Engl J Med. 1972 Aug 10;287(6):267-72. doi: 10.1056/NEJM197208102870602. No abstract available.
Lawson ML, Cash TF, Akers R, Vasser E, Burke B, Tabangin M, Welch C, Croitoru DP, Goretsky MJ, Nuss D, Kelly RE Jr. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg. 2003 Jun;38(6):916-8. doi: 10.1016/s0022-3468(03)00123-4.
Wynn SR, Driscoll DJ, Ostrom NK, Staats BA, O'Connell EJ, Mottram CD, Telander RL. Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation. J Thorac Cardiovasc Surg. 1990 Jan;99(1):41-7.
Haller JA Jr, Loughlin GM. Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines. J Cardiovasc Surg (Torino). 2000 Feb;41(1):125-30.
Zhao L, Feinberg MS, Gaides M, Ben-Dov I. Why is exercise capacity reduced in subjects with pectus excavatum? J Pediatr. 2000 Feb;136(2):163-7. doi: 10.1016/s0022-3476(00)70096-5.
Mead J, Sly P, Le Souef P, Hibbert M, Phelan P. Rib cage mobility in pectus excavatum. Am Rev Respir Dis. 1985 Dec;132(6):1223-8. doi: 10.1164/arrd.1985.132.6.1223.
Shamberger RC. Cardiopulmonary effects of anterior chest wall deformities. Chest Surg Clin N Am. 2000 May;10(2):245-52, v-vi.
Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest. 2003 Sep;124(3):870-82. doi: 10.1378/chest.124.3.870.
Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, Nuss D. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg. 2000 Feb;35(2):252-7; discussion 257-8. doi: 10.1016/s0022-3468(00)90019-8.
Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg. 2004 Mar;39(3):391-5; discussion 391-5. doi: 10.1016/j.jpedsurg.2003.11.012.
Weber TR. Further experience with the operative management of asphyxiating thoracic dystrophy after pectus repair. J Pediatr Surg. 2005 Jan;40(1):170-3. doi: 10.1016/j.jpedsurg.2004.09.039.
Fonkalsrud EW, Reemtsen B. Force required to elevate the sternum of pectus excavatum patients. J Am Coll Surg. 2002 Oct;195(4):575-7. doi: 10.1016/s1072-7515(02)01245-0. No abstract available.
Kowalewski J, Barcikowski S, Brocki M. Cardiorespiratory function before and after operation for pectus excavatum: medium-term results. Eur J Cardiothorac Surg. 1998 Mar;13(3):275-9. doi: 10.1016/s1010-7940(97)00326-6.
Other Identifiers
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FD 003341
Identifier Type: -
Identifier Source: org_study_id
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