[Coronary artery bypass grafting in a patient with a permanent tracheal stoma]

The performance of open heart surgery in a patient with a tracheostoma can present difficult problems, including mediastinitis and inadequate operative exposure. A 79-year-old man was admitted because of angina pectoris, and had undergone tracheostomy for carcinoma of the larynx 14 years previously. He underwent coronary artery bypass grafting with saphenous vein graft to # 8, 12. A skin incision was made from the angle of Louis to the xiphoid process and carried down through the subcutaneous tissue. The sternum was divided from the xiphoid process to the manubrium and then dislocated from the intact manubrium. Operative time was 165 minutes and arrest time was 64 minutes. Postoperative course was satisfactory and discharged within 24 days after operation. We think that in a case of open heart surgery with a tracheostoma no dissection near a tracheostoma is necessary in order to decrease the risk of postoperative wound infection and mediastinitis.