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Related Concept Videos

Tracheostomy Decannulation01:21

Tracheostomy Decannulation

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Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Related Experiment Video

Updated: Sep 11, 2025

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
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Delayed Sternal Closure Following Complex Cardiac Surgery in Neonates.

Amr Ashry1,2, Shubhi Gupta3,4, Hesham Hassan Ahmed5

  • 1Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK.

World Journal for Pediatric & Congenital Heart Surgery
|August 11, 2025
PubMed
Summary
This summary is machine-generated.

Delayed sternal closure (DSC) is a safe strategy for neonates after complex heart surgery, with low rates of infection and mortality. Higher Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores correlate with increased sternal wound infections.

Keywords:
congenital cardiac surgerydelayed sternal closureneonatal cardiac surgerysternal wound infection

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Area of Science:

  • Pediatric Cardiac Surgery
  • Neonatal Critical Care
  • Surgical Outcomes Research

Background:

  • Delayed sternal closure (DSC) is a strategy used in neonates following complex congenital cardiac surgery to manage hemodynamic and respiratory instability.
  • It is particularly relevant for neonates with prolonged cardiopulmonary bypass (CPB), extended aortic cross-clamp times, or deep hypothermic circulatory arrest, who are prone to myocardial edema or bleeding.

Purpose of the Study:

  • To evaluate the morbidity and mortality associated with DSC in neonates undergoing complex cardiac surgery.
  • Specifically, to assess rates of superficial and deep sternal wound infections and the need for surgical debridement.

Main Methods:

  • A retrospective review was conducted on neonates who underwent DSC after cardiac surgery between 2015 and 2021 at a single institution.
  • Data collected included patient demographics, surgical variables, intensive care unit (ICU) and hospital length of stay, and mortality outcomes.

Main Results:

  • The study included 187 neonates, with a mean age of 12.8 days and weight of 3.3 kg.
  • Sternal wound complications were low: 1.07% required debridement, and 10.2% had superficial infections.
  • Thirty-day mortality was 4.8%. Extracorporeal membrane oxygenation (ECMO) was significantly associated with 30-day mortality, while higher Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores were linked to sternal wound infections.

Conclusions:

  • Delayed sternal closure is a safe and effective therapeutic option for neonates experiencing instability after complex cardiac surgery.
  • The procedure is indicated when sternal approximation is not tolerated due to myocardial edema, hemodynamic compromise, or coagulopathy.
  • Higher RACHS-1 scores are identified as an independent risk factor for sternal wound infections in this population.