One-step surgery for cyanotic heart disease with pectus excavatum: Should it be done?

Congenital heart disease accompanied with pectus excavatum is very rare, we present our experienced in one step surgery of pectus and cardiac repair and staged procedure at our institution. We retrospectively reviewed medical records for patients who underwent a hybrid repair of both pectus and CHD between 2022 and 2023 in RSUP dr. Sardjito, Indonesia. Of these patients, 2 patients had both pectus and CHD. The first patient was using one-staged produce operation began with ASD repair than the patient proceeded with pectus repair. During pectus repair, the patient experienced worsening hemodynamics, the total operation took time seven hours. During those seven hours, there was 1400 cc of bleeding. The patient's condition was stationary and worsened within 72 hours. The patient died three days after surgery due to sepsis, MODS, and hyperlactatemia. Meanwhile the second patient underwent two-staged produce showed good result. The total duration of the operation is half shorter than the one-step operation experience, bleeding during the operation also appears to be at least 300 cc. After surgery, the patient's condition was stable and the vital sign was satisfactory. The patient currently has no complaints, including no concerns about unstable hemodynamics caused by the pectus condition. The timing and approach to surgical correction of pectus excavatum in patients with congenital heart disease must be individualized. Factors such as age, anatomical development, cardiopulmonary status, and the complexity of the cardiac defect should guide the decision between single-stage and two-stage procedures. While early intervention carries the risk of recurrence due to ongoing growth, delayed or staged surgery may offer better longterm stability and outcomes, particularly in complex or adult cases.