Cardiac damage staging in heart valve diseases. “Metastatic disease or synchronous neoplasms”

The concept of cardiac damage staging in left-sided heart valve disease, adapted from the oncological approach, has been developed recently in order to improve the management of patients who may benefit from valve repair or replacement interventions. However, the cardiac damage is frequently not directly related to the valve disease, and cardiac and extra-cardiac non-valvular comorbidities influence the staging, unlike oncological staging where the associated damage all comes from the primary tumor. In practice, the cardiac damage classification is more an assessment of overall heart health than the direct consequences of valvular heart disease, and some cardiac damages are independent of the valve disease. Anyway, the cardiac damage staging remains a powerful predictor of outcome, especially after valve intervention. This viewpoint explores the concept of cardiac damage staging and the impact of the valve intervention on this classification.