Surgical strategies for mitral valve diseases associated with pectus excavatum: a narrative review of approaches and outcomes

OBJECTIVES: To develop a decision-making framework for the surgical management of coexisting mitral valve (MV) prolapse and pectus excavatum, addressing the challenges posed by anatomical complexity and functional compromise. METHODS: A narrative review of reported cases involving coexisting MV prolapse and pectus excavatum was conducted. Each case was analysed to evaluate the characteristics, personalized surgical strategies and operational details, with a focus on the associated benefits and risks. Additionally, surgical strategies were classified, and process management approaches were explored to guide treatment planning. RESULTS: The management of coexisting MV prolapse and pectus excavatum was categorized into three tailored approaches: (i) isolated chest wall reconstruction for cardiac decompression in patients with preserved valvular function; (ii) standalone MV repair or replacement for severe regurgitation with mild-to-moderate skeletal deformity (Haller index <3.5) and (iii) single-stage combined procedures for complex presentations (Haller index ≥3.5). A framework for personalized treatment pathways was proposed, incorporating factors such as deformity severity, surgical history and haemodynamic status to optimize approach selection. CONCLUSIONS: The integration of innovative surgical techniques and minimally invasive approaches offers the potential for safe and effective outcomes. A personalized, anatomically stratified approach is essential for optimizing treatment strategies in patients with this complex comorbidity.