[Post-tracheostomy cicatricial tracheal stenosis with postoperative total sternal instability in a patient with severe concomitant cardiac disease].

Treatment of cicatricial tracheal stenosis combined with postoperative sternal instability is a difficult objective. A 53-year-old patient with multiple previous tracheostomies and compensated tracheal stenosis underwent surgical correction of congenital heart disease in childhood. Heart failure progression occurred in 2017. The patient was examined. Mitral and tricuspid valve defect was diagnosed. Mitral valve replacement and tricuspid valve annuloplasty with radiofrequency ablation (RFA) of the right atrium were scheduled. To provide anesthesia, the patient underwent repeated tracheostomy that was complicated by atrial fibrillation. After stabilization of clinical condition, mitral valve replacement and tricuspid valve annuloplasty with radiofrequency ablation were performed. Postoperative period was complicated by cicatricial tracheal stenosis and total chest instability. A two-stage surgical treatment including circular tracheal resection with anastomosis and repeated sternal osteosynthesis with a titanium implant was performed. This approach ensured favorable functional outcome. In these patients, treatment strategy cannot be standardized and requires a personalized approach together with appropriate surgical experience.