Heart Team: Traditional and Expanded!

Heart Team: Traditional and Expanded!

The traditional Heart Team includes clinical or non-invasive cardiologists, interventional cardiologists and cardiac surgeons and is entrusted the process of balanced decision making in case of interventional or surgical therapies for stable, complex coronary artery disease. The concept of a multidisciplinary Heart Team was developed by the SYNTAX Investigators [1] and endorsed by the European (ESC/EACTS) Guidelines on Myocardial Revascularization 2010 [2].

An interesting study by Long J and colleagues [3] found that re-discussion of same patient data one year later yielded a different advice in about a quarter of the cases, suggesting that in certain cases of coronary artery disease, both coronary artery bypass grafting and percutaneous coronary intervention might be appropriate. A later review on the concept adds on shared decision making with the patient for optimal treatment strategy in stable complex coronary artery disease [4].

The discussion so far is on the traditional heart team which also includes the patient in the shared decision making process. An updated and expanded concept includes many other medical and paramedical professionals and administrative professionals along with the patient and family. Some team members may not be needed in case of all procedures like the presence of a cardiac surgeon which is not needed in case of electrophysiology procedures [5].

Those who wish to know more about the expanded concept of heart team may kindly refer to the guidance published in May 2022, cited as reference number 5 here. The multi disciplinary team covers cases of myocardial revascularization, aortic valve disease, mitral and tricuspid valve disease and endocarditis.

References

1. Guidelines on myocardial revascularization. European Heart Journal Oct 2010, 31 (20) 2501-2555.
2. Serruys PW et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009 Mar 5;360(10):961-72.
3. Long J, Luckraz H, Thekkudan J, Maher A, Norell M. Heart Team discussion in managing patients with coronary artery disease: outcome and reproducibility. Interact CardioVasc Thorac Surg 2012;14(5):594–598.
4. Head SJ, Kaul S, Mack MJ, Serruys PW, Taggart DP, Holmes DRJr., Leon MB, Marco J, Bogers AJ, Kappetein AP. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur Heart J 2013;34(32):2510–2518.
5. Archbold A, Akowuah E, Banning AP, Baumbach A, Braidley P, Cooper G, Kendall S, MacCarthy P, O’Kane P, O’Keeffe N, Shah BN, Watt V, Ray S. Getting the best from the Heart Team: guidance for cardiac multidisciplinary meetings. Heart. 2022 May 12;108(11):e2. doi: 10.1136/heartjnl-2021-320510. PMID: 35396217.