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Coronary bypass by complete sternotomy in a patient with a tracheostoma

^a Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Foresterhill Road; Foresterhill, Aberdeen AB25 2ZN, Scotland, UK
^b Department of Anesthesia, Aberdeen Royal Infirmary, Foresterhill Road; Foresterhill, Aberdeen AB25 2ZN, Scotland, UK

^* Corresponding author. Tel.: +44-1224-553-773
rrjeffrey{at}abdn.ac.uk

Patients with a laryngectomy pose a challenge when they require cardiac surgery. Dissection of the manubrium and sternal notch from surrounding soft tissues can be hazardous, as it may result in troublesome bleeding and inadvertent tracheal injury, especially in those patients, in whom the trachea is displaced anteriorly, or lies close to the sternal notch, as a result of a ‘low’ tracheal stoma. Performing a median sternotomy in such patients is believed to substantially increase the risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injuries, leading to several modifications of conventional median sternotomy, including bilateral thoracotomy incisions and limited median sternotomy approaches. There is only one case reported in the literature wherein cardiac surgery was done in such a patient, through a full sternotomy. This report describes a successful coronary artery bypass grafting through a complete median sternotomy, with no complications. This approach permitted adequate operative exposure and separated the stoma from the operative field. We also review alternative modalities of access, in these patients.

Key Words: Coronary artery bypass grafting; Tracheotomy; Sternotomy; Limited sternotomy; Thoracotomy