Objective: Various surgical accesses for pericardial fenestration are described and used in the literature. Each of them has its advantages and disadvantages depending on the cause of the need for pericardial fenestration. Results: Operative and perioperative mortality has not been reported. Operative complications such as bleeding, injury to the coronary artery or myocardium have not occurred. Substernal access after resection of the xiphoid process is a safe and effective approach for surgical treatment of pericardial tamponade.