Aortic valve replacement after substernal colon interposition

A 60-year-old man with a history of esophageal resection and substernal colon interposition required aortic valve replacement for aortic stenosis. The aortic valve was approached through an 8-cm right parasternal incision over the third and fourth costal cartilages with cardiopulmonary bypass using cannulas in the right femoral artery and vein and the right atrium. The right parasternal approach provided safe exposure of the aorta and left ventricular outflow tract when substernal abnormalities precluded conventional median sternotomy.