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Case of the Month: Cardiac Complications 

Friday, December 12, 2025

Each month, thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian spotlights unique surgical cases in cardiothoracic surgery through this Case of the Month series. For more videos in this series, click here.  

In this second episode of the Case of the Month, thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian is joined by cardiac surgeon and CTSNet Senior Editor Lorena Montes, nurse CTSNet Senior Editor Cristina Ruiz Segria, and nurse educator Jill Ley. They present part 1 of the case on “Cardiac Complications.” Dr. Ashrafian provides an overview of the patient’s medical history, along with the investigation findings from the electrocardiogram. Additionally, she discusses the surgical treatment and postoperative course.  

In part 2 of this case study, thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian, cardiac surgeon and CTSNet Senior Editor Lorena Montes, nurse and CTSNet Senior Editor Cristina Ruiz Segria, and nurse educator Jill Ley discuss the next steps that were taken. They explore the timing and surgical plan, including the expected findings and potential complications. They also examine the postoperative outcomes and what can be learned from this case. Additionally, each expert shares their insights and opinions on the case, detailing what they would have done differently.  


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Comments

We dont know enough about this patient to offer ideas. Did he have pre op cerebral issues, for instance alcoholism? Did he have cultures before antibiotics started? What were his blood gases? What did his Cxr and routine lab show? Any physical exam findings?
Thank you for your comments. Unfortunately as this was taken from an expert witness medical case we do not have those details. We completely agree the relevance of all of these points though and they are indeed fundamental to understanding the whole scenario. Given the limited information available, we hope this case rather highlights the potential dangers of severe deep sternal infection and offers insights on early detection and prevention .
These days we definitely like to move patients along when they are on a typical post op course, but when they fall off more agressive management may be needed. I havent seen this type of dehiscence in a while, but I do recall managing these patients with paralysis while on the vent, prior to reclosure, to prevent this exact event of the heart tearing against the sternal edge. And personally I try to avoid going any longer than 24 hours between recognition of the wound issue and rexplortion for reclosure, debridement and vac closure, or flap closure depending on findings.

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