The thoracic approach for cardiac surgery in a patient with a tracheostoma can
result in difficult problems, such as mediastinitis, stoma necrosis or inadequate
operative exposure. We present a distinct approach consisting of an incision at
the second intercostal space, transverse sternum transection and longitudinal
median sternotomy to the xiphoid process, performed for coronary artery bypass
grafting and aortic valve replacement, in a patient with previous tracheotomy.
This approach permitted adequate surgical exposure for cardiopulmonary bypass,
aortic valve replacement and coronary revascularization procedures
