Surgical procedures and follow up.
All patients were given lipid-lowering drugs and beta-blocker prior to the operation. Except for case 2, the patients were discontinued from clopidogrel and aspirin seven to eight days before surgery, and low molecular weight heparin (4100 U, q12h) was injected subcutaneously for bridging. During the bridging process, severe angina or chest tightness did not occur in any case, nor did gastrointestinal bleeding occur. Case 2 had severe coronary artery stenosis before surgery and presented with left heart failure, while antiplatelet drugs, cardiotonic diuretics and other drugs did not improve the patient’s condition. After implantation of an intra-aortic balloon pump (IABP), the blood flow was stable enough to perform an emergency OPCAB and radical resection of the gastric cancer.
All the patients were operated on by the same group of cardiac and gastrointestinal surgeons. OPCAB was performed first, followed by radical cancer resection of the gastrointestinal tumors. After conventional anesthesia, a median incision was made into the chest to harvest the internal mammary artery, the great saphenous vein, and the left radial artery as graft vessels. Heparin (1 mg/kg) was administered intravenously before the graft was disengaged. The proximal end of the graft was sutured to the aorta using 5-0 prolene, and the distal end was sutured to the coronary artery using 7-0 prolene. After completion of the grafting, protamine sulfate (1.5x the amount of heparin) was administered for heparin neutralization. After rigorous maintenance of hemostasis and placement of a thoracic drainage tube, the chest was closed. The abdomen was then disinfected again, and a midabdominal incision was made approximately 5 cm from the lower edge of the chest incision to perform the radical resection of the gastrointestinal tumor. All patients underwent an R0 resection and standard lymph node dissection. Negative pressure drainage was established, and gastric cancer patients were fitted with a nasal nutrition tube (Table 3).
Following the operations, patients were placed in the intensive care unit for monitoring. The IABP was removed shortly after the operation, and the tracheal intubation was removed at the appropriate time. Patients with gastric cancer received enteral nutrient solution, aspirin, clopidogrel, beta-blockers, and lipid-lowering drugs through the nasal feeding tube beginning from the first day after surgery. Patients with colorectal cancer received intravenous nutrition and low molecular weight heparin (4100 U, q12h) was injected subcutaneously from the first postoperative day. After eating, the patients were given the above drugs orally. The drainage tube was removed when the pleural mediastinal drainage was less than 200 mL/day. After confirming that there were no gastrointestinal fistulas, the abdominal drainage tube and enteral feeding tube were removed and the patients were discharged. The patients were prescribed additional medication and were followed up regularly (Table 4).