Background: Since esophagectomy can incur significant mortality and morbidity, past medical and surgical history should be factored into the risk/benefit analysis. However, no data exists to quantify risk due to cardiac surgery prior to esophagectomy. Methods: We retrospectively reviewed all patients at our institution (1984-2004) who underwent esophagectomy after cardiac surgery. Results: There were 27 patients (26 men). Median age was 68 years (range, 50-81). Median follow-up was 41 months (range, 2-123). The median interval from sternotomy to esophagectomy was 54 months (range, 1 week-8.9 years). Prior cardiac surgical procedures included 22 coronary revascularizations (3 with concomitant valve procedure) and 5 valve procedures. Significant peripheral vascular disease was present in 7 patients (26%). Indications for esophagectomy included carcinoma in 26 and benign perforation in 1. Esophagectomy approach included 20 Ivor Lewis, 5 transhiatal and 2 thoraco-abdominal resections. Operative mortality was nil and no perioperative coronary events occurred. Complications included anastomotic leak in 3 patients (11%) including gastric conduit necrosis in 1 (4%), atrial fibrillation in 5 (19%), wound dehiscence in 2 (7%), pneumonia in 2 (7%), and temporary vocal cord paralysis in 1 (4%). Clinically significant strictures requiring dilatation occurred in 11 patients (41%). Overall 5-year survival was 61% (95% confidence interval (CI): 45-84%). Five-year survival in patients who had a CABG was 58% (95% CI: 40-83%) and 80% (95% CI: 52-100%) in patients who had only a valve procedure (p=0.53). Two-year survival in patients with early stage esophageal cancer (high grade dysplasia or stages 1 or 2) was 90% (95% CI: 77-100%) and significantly higher than the 50% (95% CI: 25-100%) in patients with advanced stage (stage 3 or 4; p=0.0001). Conclusions: Esophagectomy after cardiac surgery is not associated with either increased operative mortality or postoperative coronary events. Although previous cardiac surgery may indicate increased risk for peripheral vascular disease, few postoperative complications attributable to peripheral vasculopathy were encountered. Patients should not be denied esophagectomy based solely on prior cardiac surgery.