Abstract
Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Their surgical management can be complicated by severe comorbidities, particularly advanced cardiovascular disease. We report a case of gastric GIST in a patient with ischemic cardiomyopathy, recurrent coronary interventions, and reduced ejection fraction, requiring implantable cardioverter-defibrillator (ICD) placement prior to tumor resection. Case presentation: A 67-year-old man with a history of myocardial infarction, coronary artery bypass grafting, multiple percutaneous coronary interventions, and chronic heart failure presented with dyspnea, chest discomfort, and fatigue. During evaluation, an ulcerated gastric mass (cT3N0) consistent with GIST was identified. Echocardiography revealed an ejection fraction of 35–37% with apical aneurysm. Holter monitoring showed marked bradyarrhythmia and atrioventricular block. Given the high anesthetic risk, a multidisciplinary tumor board recommended initial cardiac optimization. The patient underwent implantation of a dual-chamber ICD (Biotronik Rivacor 5 MRI DR) and was stabilized with guideline-directed medical therapy and intermittent levosimendan infusion. Outcome: Following optimization, the patient’s clinical status improved, with ejection fraction increasing to 37% and resting heart rate stabilized around 56 bpm. He subsequently underwent partial gastrectomy with duodenal anastomosis. Histology confirmed a low-risk GIST (M8936/3, <5 mitoses/50 HPF). The postoperative period was uneventful. Conclusion: This case highlights the importance of a multidisciplinary, staged approach in managing oncological patients with advanced cardiovascular disease. Preoperative ICD implantation and optimization of heart failure therapy enabled safe surgical resection of gastric GIST.