Minimally invasive direct coronary artery bypass in a patient with combined severe coronary artery disease and pancreatic ductal adenocarcinoma

Treatment of severe coronary artery disease in patients with a malignancy is challenging. A 74-year-old man was presented in critical condition because of cardiac rupture after inferior myocardial infarction. Pericardiocentesis rescued the patient from shock. A pancreatic tumor, which was suspected to be malignant, was an incidental discovery on computed tomography (CT). Coronary artery angiography revealed severe stenosis of the left anterior descending (LAD) artery and moderate stenosis of the left circumflex (LCX) artery. Minimally invasive direct coronary artery bypass (MIDCAB) for the LAD artery was performed, and 3 months after the MIDCAB, the patient underwent distal pancreatectomy. Pathological evaluation revealed pancreatic ductal adenocarcinoma. Both surgical treatments were successfully performed and the postoperative course was uneventful. MIDCAB for the LAD artery prior to surgical tumor resection is an effective and reliable myocardial revascularization in patients with combined severe coronary artery disease and a malignancy.