Management of severe valvular heart disease in patients with active cancer: a French multidisciplinary position paper

The co-existence of valvular heart disease (VHD) and active cancer presents a unique clinical challenge, necessitating an individualized multidisciplinary strategy to balance oncologic treatment urgency with cardiovascular risk. The indication, optimal timing, and modality of VHD intervention in patients with active cancer remain unclear, particularly given the risks of cancer treatment-related cardiac dysfunction, perioperative complications, delays in oncologic therapy, and the cancer prognosis. This multidisciplinary position paper aims to provide evidence-based suggestions on the management of severe VHD in active cancer patients, focusing on (i) risk stratification of VHD in cancer patients, including the impact of chemotherapies, targeted therapies, and non-cardiac surgery, (ii) indication and timing considerations for cardiac intervention to minimize oncologic treatment delays, and (iii) comparison of surgical vs percutaneous interventions, highlighting patient selection criteria. A conservative approach should be discussed insofar as it does not limit access to optimal oncology care. Percutaneous interventions should be favoured when feasible to minimize oncologic delays (<4 weeks), while surgical approaches remain essential in select cases with anatomical contraindications. Future research should focus on prospective studies.