AIM: To evaluate the safety, efficacy, and technical considerations in microwave ablation (MWA) of lung tumours close to the heart and aorta. MATERIALS AND METHODS: A retrospective cohort study at a high-volume interventional oncology centre between January 2017 and June 2024 was performed. Ablations of lung tumours <10 mm from the heart and/or aorta were included. Efficacy outcomes included technical success, ablation success, and oncological success. Safety outcomes included clinical success and complications. RESULTS: 40 patients with 44 tumours met the inclusion criteria. The median tumour size was 14 mm (interquartile range [IQR] 10-22 mm; range 5-50 mm). Technical success was 100%. Ablation success was 95.4%. The severe complication rate was 2.5%. The cardiac complication rate was 5%, including a case of systemic air embolism and a first-degree heart block. Oncological success at 1 year was 87.1%. The technical nuances contributing to the safe performance of these procedures were described. CONCLUSION: Percutaneous microwave ablation can be a safe and effective treatment for lung tumours close to the heart and aorta.