Statis, Joshua Ryan

12y · Male·Cardiac haemorrhage due to or as a consequence of congenital aortic stenosis (surgically repaired); rupture of right ventricular outflow tract CardioCel patch

Joshua Statis, a 12-year-old with complex congenital aortic stenosis, died 18 days after a redo Konno procedure and aortic valve replacement when a CardioCel patch to the right ventricular outflow tract (RVOT) ruptured, causing catastrophic bleeding. He developed a sternotomy wound infection 9 days post-operatively, returned to theatre for debridement with VAC dressing on day 15, and acutely bled 18 days post-operatively. Key clinical lessons: (1) Communication between surgical and intensivist teams was suboptimal—the consultant surgeon underestimated bleeding severity based on incomplete information; (2) Earlier consultant-to-consultant discussion might have triggered earlier consideration of bypass; (3) The Surgical Fellow's call-in duties distracted from bedside clinical assessment; (4) Documentation by the cardiac surgical team was absent, limiting retrospective review. However, expert consensus concluded that even with earlier theatre activation and bypass ready, survival was extraordinarily unlikely given the catastrophic right ventricular bleed. The cause of patch inflammation remains uncertain—low-grade infection, VAC dressing effects, or both are possible.