Title Alternative redo sternotomy in a patient with tracheostoma andpatent grafts

(95 words) We describe a redo operation in a patient with a tracheostoma and patent bypass grafts to the coronary arteries. Preoperative investigations revealed that the patent’s right internal thoracic artery graft ran directly under the sternum just anterior to the ascending aorta, and the saphenous vein graft was adhering to the surgical wire. In order to prevent injury to the patent grafts and cardiac structures, and to avoid communication with the tracheostoma, the redo procedure was performed via an anterior minithoracotomy combined with a low T-shaped partial sternotomy. The reoperation was successfully completed without any complications.