title: Aortic surgery in Marfan patients with severe pectus excavatum.
abstract: OBJECTIVE
  The optimal surgical management of the aortic root phenotype Marfan patients with severe pectus excavatum is a subject of debate. All the available literature were reviewed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) principles in order to assess the early outcomes of both pectus excavatum and aortic repair techniques.
  
  
  METHODS
  Searches were done in PubMed and MEDLINE electronic databases dating from July 1953 to December 2015.
  
  
  RESULTS
  A total of 97 peer-reviewed publications were retrieved, and 27 relevant publications were identified with a total of 39 Marfan patients with pectus excavatum who underwent ascending aorta and aortic root surgery. Emergency acute Type-A aortic dissection repair was reported in five cases. Concomitant pectus excavatum and aortic root repair and composite graft implantation were the most commonly performed procedures. Complications after a staged or a combined approach were uncommon and no deaths occurred.
  
  
  CONCLUSIONS
  Aortic surgery in Marfan patients with pectus excavatum was carried out according to a variety of strategies, surgical techniques and accesses with low complications rate and no mortality. Many of these were well tolerated with minimal complications and no mortality.
authors.affiliation: aDepartment for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), via E. Tricomi n. 5, 90127, Palermo, Italy bDepartment of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Maria Curie Sklodowska Str 9. 85-094, Bydgoszcz, Poland cUniversity Hospital Southampton NHS Foundation Trust, Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6YD, United Kingdom.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Raffa
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Malvindi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bertani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romano
authors.forename: Sergio
authors.initials: S
authors.lastname: Sciacca
authors.forename: Marco
authors.initials: M
authors.lastname: Turrisi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armaro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stringi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalbano
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mattiucci
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Follis
authors.forename: Michele
authors.initials: M
authors.lastname: Pilato
mesh_terms: D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005660:Funnel Chest / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013249:Sternum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult