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Introduction Pectus excavatum (PE) is a posterior depression of the sternum commonly corrected with the Nuss procedure. Exercise intolerance is frequently reported, yet longitudinal cardiopulmonary changes after surgery remain unclear. We assessed cardiopulmonary exercise testing (CPET) and pulmonary function test (PFT) indices pre operatively, with bars in situ, and one year after bar removal.Methods This retrospective study included 18 patients who completed PFTs and CPET at three time points: pre operative (Pre), ~1 year post surgery (Bars IN), and ~3 years post surgery (Bars OUT). CPETs were performed on a cycle ergometer with an incremental ramp protocol. Outcomes were VO2peak z score (primary), peak power (z), O2 pulse (z), anaerobic threshold (AT, z), FEV1 (z), FVC (z), breathing reserve at peak (BR, %), and peak heart rate (HRpeak, bpm). Repeated measures ANOVA tested the Time effect (3 levels); Greenhouse–Geisser correction was pre-specified if sphericity was violated. Bonferroni adjustment was applied to pairwise comparisonsResults Eighteen patients (16 male) provided complete data at all time points; 61% reported sedentary activity. Pre operatively, 56% had VO2peak below the lower limit of normal. VO2peak z score did not change across time (p=.174). Peak power z decreased overall (p=.008), with Pre > Bars OUT (mean difference 0.73 z units, p=.011). O2 pulse z and AT z were unchanged (p≥.145). FVC z improved (p=.013), with Bars OUT > Pre (p=.026). FEV1 z showed a nonsignificant omnibus effect (p=.080) but a significant linear trend indicating gradual improvement (p=.040). For absolute responses, BR increased overall (p=.038; pairwise ns), and HRpeak decreased (p=.038) with Pre > Bars OUT (p=.044). Table 1Conclusion Over half of the patient’s demonstrated a reduced aerobic capacity pre-operatively. Across three years after Nuss repair, VO2peak z score remained broadly stable, whereas peak power declined and FVC improved, with FEV1 showing a modest linear increase. BR rose and HRpeak fell, suggesting small shifts in ventilatory and chronotropic responses rather than uniform enhancement of exercise capacity. The decline in peak power may reflect behavioural and lifestyle factors (e.g., lower physical activity as adolescents transition to young adulthood) and warrants investigation in larger, prospective cohorts.Abstract P46 Table 1Reported mean with 95% CI