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

Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.