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.