CONGRESS ABSTRACT

A 71-years-old man with multiple cardiovascular risk factors and an old history of paroxysmal AF (non-anticoagulated due to a single episode in youth) was diagnosed with a non-metastatic adenocarcinoma of gastric fundus judged resectable. During infusion of the third cycle of pre-operative CT with FLOT he experienced transitory chest pain with the development of sharpened T waves with a high J point in antero-lateral leads at the EKG during the symptom (fig. 1). The episode was at first considered compatible with vasospasm induced by 5-FU, but a CT scan was nonetheless performed showing a severe three-vessel CAD involving the left main coronary artery (fig. 2), confirmed by the coronary angiography. A normal systolic function was found at the cardiac ultrasound. After the multidisciplinary team including cardiologists, cardiac surgeons, anaesthesiologists, oncologists and gastric surgeons discussed the case, the patient was referred to an urgent off-pump single CABG of the LAD coronary artery with LIMA. That allowed the non-delayable program of total gastrectomy – which was conducted for weeks later – in a safe setting by revascularizing the prognostic vessel and avoiding the DAPT related to a PCI (an eventual bridge therapy with intravenous P2Y12 inhibitors during the first month of stenting of a critical coronary artery was considered at high risk); in addition, the choice of OPCAB prevented the augmented risk of complications of extracorporeal circulation described in oncologic patients such as bleeding and higher mortality (Vieira et al, 2012). Once no residual local or metastatic disease was established, a complete revascularization was performed in election few weeks later by PCI of the residual vessels, which avoided the problems related to a re-sternotomy of a possible second CABG with venous grafts. After six months, the patient was still alive and concluded the remaining two cycles of adjuvant CT safely.