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In this retrospective cohort of 253 patients with Marfan syndrome undergoing aortic surgery, the authors evaluated the impact of severe pectus excavatum (Haller index >3.5; n=62) vs non-severe or no pectus excavatum (PE) (n=191). Patients with severe PE were younger and had reduced pulmonary function and smaller left ventricular (LV) dimensions preoperatively, while operative characteristics were comparable. No early mortality occurred. Prolonged mechanical ventilation was more frequent in the severe PE group (8.0 percent vs 1.7 percent; P=0.013), though this association attenuated after correction of the model. At 10 years, overall survival (98.3 percent vs 96.8 percent; P=0.69) and event-free survival (82.0 percent vs 77.2 percent; P=0.66) appeared similar. Severe uncorrected PE was not associated with different long-term outcomes, although the authors state that careful perioperative respiratory management remains warranted.
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