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Cardiovascular Vulnerability, Including Heart Failure Risk, in Breast Cancer Surgery: The Role of Operative
Andrei Marginean1, Madalin Margan2, Dragos-Mihai Gavrilescu3
1Department of Surgery, "Dr. Victor Popescu" Emergency Military Hospital, 9 Gheorghe Lazăr Street, 300080 Timișoara, Romania.
Medicina (Kaunas, Lithuania)
|May 27, 2026
Summary
Older patients undergoing breast cancer surgery face increased risks from cardiovascular disease and frailty. Tailoring surgical complexity to individual patient profiles is crucial for better outcomes.
Area of Science:
- Oncology
- Cardiology
- Geriatrics
Background:
- Breast cancer surgery is increasingly common in older, multimorbid patients.
- Cardiovascular disease and frailty significantly impact perioperative risk, including heart failure.
- Existing studies often lack integrated frameworks for surgical complexity, cardiovascular comorbidity, and frailty.
Purpose of the Study:
- To review and synthesize evidence on perioperative outcomes in breast cancer surgery.
- To examine the interplay of surgical complexity, cardiovascular vulnerability, and frailty.
- To inform risk-adapted surgical strategies for older breast cancer patients.
Main Methods:
- Systematized narrative review of PubMed/MEDLINE, Scopus, and Web of Science.
- Inclusion of studies reporting early postoperative outcomes related to comorbidities, cardiovascular risk, or frailty.
- Data synthesis following PRISMA 2020 principles, organized by surgical complexity, cardiovascular vulnerability, and frailty.
Main Results:
- Nineteen studies analyzed diverse breast surgery populations, including elderly and reconstructive cohorts.
- Increased surgical complexity (conserving surgery to mastectomy to reconstruction) correlated with higher complications.
- Frailty independently predicted 30-day complications, mortality, and readmissions across all surgical types.
- Cardiovascular disease amplified morbidity; heart failure patients showed heightened vulnerability, though HF events were rarely isolated outcomes.
Conclusions:
- Breast cancer surgery outcomes depend on the interaction of surgical complexity, cardiovascular comorbidity, and frailty.
- A patient-centered, risk-adapted strategy is recommended, tailoring surgery to cardiovascular profile and frailty.
- Integrating frailty assessment and cardio-oncologic evaluation can improve risk stratification and reduce complications in aging populations.
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