Patients
A total of five patients underwent OPCAB and radical resection of a
gastrointestinal tumor in Huashan Hospital, affiliated with Fudan
University, between September 2010 and October 2019 (Table 1). All five
patients were male and the average age was 61.8 years. Three patients
with gastric cancer were admitted to hospital due to discomfort in the
upper abdomen after eating, among which two patients had accompanying
unstable angina pectoris and one patient had severe left heart failure.
There were two patients with colon cancer. One of these patients was
admitted to hospital due to unstable angina pectoris; preoperative
examination revealed low hemoglobin, and colonoscopy revealed a colonic
tumor at the hepatic flexure. The second patient with colon cancer was
admitted due to incomplete intestinal obstruction and unstable angina
pectoris. All five patients underwent preoperative evaluations,
including clinical history, physical examination, routine blood
examination of liver and kidney function, gastroenteroscopy, abdominal
and chest computed tomography (CT) scans, and others. All patients were
pathologically diagnosed with adenocarcinoma prior to surgery.
The electrocardiogram and/or clinical symptoms of all five patients
suggested a history of coronary heart disease. All patients underwent
coronary angiography and transthoracic echocardiography before the
operation (Table 2), which confirmed severe coronary heart disease
including three-vessel, left main, and main-like disease, all requiring
coronary artery bypass grafting (CABG). Coronary angiography of Case 5
was shown in Fig.1 .Transthoracic echocardiography indicated
that the left ventricular ejection fraction (LVEF) was 56.8% (45-65%)
on average. According to the preoperative NSQIP-MICA score, the risk of
perioperative myocardial infarction and cardiac arrest was extremely
high.