Cardiac surgery in patients with malignancy: A literature review and recommendations for perioperative management

An increasingly aged population, early cancer diagnosis and new oncology and surgical therapies that improve survival favor the presentation of cancer patients who are simultaneously affected by a cardiac disease requiring surgery. Oncological therapy can lead to cardiovascular injury, impacting surgical strategies and risk. Current opinion in patients affected by concomitant heart disease and cancer is to give priority to the surgical treatment of cardiac disease, thus allowing the treatment of neoplasm in an active or advanced stage, either by surgical resection or by means of radiation and oncology therapies. Therefore, prior to heart surgery, tumor staging, assessment of prognosis, as well as the interaction between tumor and extracorporeal circulation and the possibility of being able to improve survival with appropriate therapies even in advanced stages, are crucial. Then, an adequate preoperative screening of cardiovascular abnormalities related to antitumoral therapy and the assessment of other conditions linked to the type of cancer, are both extremely important to decide the most appropriate surgical approach. Careful evaluation of the association of cardiovascular diseases and the prognosis of the active or remitted malignancy should be established to improve the prediction of short-, medium- and long-term outcomes. This article aims to review the literature on cardiovascular effects of antitumoral therapy in cardiac surgery candidates. Moreover, the authors provide an overview of the factors that should be considered in patients with a prior history of malignancy or with active cancer, who need cardiac surgery.