Coronary artery bypass grafting in patients with a tracheostoma: use of a bilateral thoracotomy incision.

The performance of cardiac surgical procedures via median sternotomy in patients with a tracheostoma can present difficult problems, including stomal necrosis, mediastinitis, and inadequate operative exposure. Bilateral thoracotomy is an alternative approach in such patients. This approach separates the stoma from the operative field and provides satisfactory exposure for internal mammary artery dissection and performance of coronary artery bypass grafting.