Objective To compare the clinical outcomes of two percutaneous tracheostomy methods, the guide wire dilating forceps (GWDF) and the single step dilational tracheostomy (SSDT), in patients having received cardiac surgery. Methods Totally 60 patients, who underwent mid-sternal thoracotomy from October 2011 to August 2013 and had tracheostomy indications, were included in the present study. The patients were equally divided into GWDF group and SSDT group. The operation time, times of dilation, blood loss, and postoperative complications were compared between the two groups. Results The operation time of tracheostomy in the SSDT group was significantly shorter than that in the GWDF group ([6.5±2.2] min vs [9.3±3.1] min,P=0.02). The times of dilation of the SSDT group was significantly less than that of the GWDF group (1.10±0.05 vs 1.53±0.22, P=0.001); the blood loss was also significantly less than that of the GWDF group (P=0.000). The overall complication rate of the SSDT group was significantly lower than that of the GWDF group (P=0.000). Conclusion SSDT, compared to the GWDF, has the advantages of simple manipulation, short operation time, less trauma, and less complication, and it can be used as the first choice for severe patients after cardiac sugery.