Aortic valve replacement after substernal colon interposition

A 60-year-old man with a history of esophageal resection and substernal col on interposition required aortic valve replacement for aortic stenosis, The aortic valve was approached through an 8-cm right parasternal incision ove r the third and fourth costal cartilages with cardiopulmonary bypass using cannulas in the right femoral artery and vein and the right atrium. The rig ht parasternal approach provided safe exposure of the aorta and left ventri cular outflow tract when substernal abnormalities precluded conventional me dian sternotomy. (Ann Thorac Surg 1999;67:838-9) (C) 1999 by The Society of Thoracic Surgeons.