Multistage cardiac surgery, extracorporeal membrane oxygenation, and advanced wound care in a critically ill neonate: a case report

Neonates with complex congenital heart disease (CHD) frequently require early and staged surgical interventions, which carry a high risk of postoperative complications. The coexistence of an interrupted aortic arch, ventricular septal defect (VSD), and mitral valve stenosis represents a rare and particularly high-risk constellation. This case is noteworthy for the integration of multistage cardiac surgery, prolonged extracorporeal membrane oxygenation (ECMO), and an innovative wound management strategy combining negative pressure wound therapy (NPWT) with topical oxygen-enriched gel. We report the case of a one-month-old Romanian female infant diagnosed with type A interrupted aortic arch, VSD, and mitral valve stenosis. The initial surgical procedure included aortic arch reconstruction, VSD closure with a bovine pericardial patch, and mitral valve repair. Severe residual mitral regurgitation necessitated immediate initiation of veno-arterial ECMO, followed by mitral valve replacement with a Melody bioprosthesis. On postoperative day 19, thrombotic obstruction of the prosthetic valve required a third surgical intervention for clot removal, after which ECMO was discontinued. Delayed sternal closure was performed on day 26, but wound dehiscence developed on day 33. Management included NPWT combined with topical oxygen-enriched gel for 33 days, followed by gel monotherapy for 38 additional days. Complete secondary intention healing was achieved after 73 days. Despite developing Pseudomonas aeruginosa sepsis and late-onset Staphylococcus haemolyticus bacteremia, the patient recovered fully without neurological deficits or wound-related sequelae. This case highlights the feasibility of combining advanced surgical management with innovative wound care strategies in critically ill neonates with complex CHD. The successful integration of NPWT and topical oxygen therapy promoted wound healing after delayed sternal closure, even in the context of severe infection and prolonged ECMO support. These findings suggest that tailored, multidisciplinary approaches may optimize outcomes in high-complexity neonatal cardiac cases.