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- heart valve diseases
- aortic valve stenosis
- mitral valve insufficiency
- coronary artery disease
- tricuspid valve insufficiency
The concept of a Heart Team approach to evaluating patients with cardiovascular disease was fuelled by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial for severe coronary artery disease and the Placement of Aortic Transcatheter Valves (PARTNER) trial for aortic stenosis (AS).1 2 It was subsequently included as a recommended practice in guidelines for the management of patients with coronary artery disease and AS.3–5 Unpacking the rationale, purpose, composition, process and work of the Heart Team has been an evolving process that is being increasingly applied to additional cardiovascular diseases. Professor Ray and working group colleagues provide a consensus statement which outlines guidance from the British Societies regarding the multidisciplinary meetings of the Heart Team to address myocardial revascularisation; aortic, mitral and tricuspid valve disease; and endocarditis (figure 1).6
Rationale for multidisciplinary Heart Team evaluation
Multiple factors provide strong rationale for the growing need for multidisciplinary Heart Team evaluation of patients with cardiovascular disease. There is rapid evolution of clinical trial data, device options and refinement, procedural innovations and guidelines. Disease complexity may require additional testing and expertise to determine disease severity. The optimal approach to disease intervention—transcatheter, surgical or a hybrid—requires expert knowledge of anatomical and procedural nuances that directly influence the risks versus benefits of different approaches. Concomitant disease (eg, aortic dilation in a patient with bicuspid AS; severe primary mitral regurgitation (MR) in a patient with severe AS) may influence the optimal treatment plan. For several cardiovascular diseases, recommendations for and clinical trials testing the optimal timing of intervention evolve quickly, making it very difficult for generalists to stay up-to-date. Finally, for the patient to meaningfully contribute to treatment decisions in a shared decision-making process, …
Contributors BRL and KG co-wrote the editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Dr BL has served on the scientific advisory board for Roche Diagnostics, has received research grants from Edwards Lifesciences and Roche Diagnostics, and has consulted for Medtronic. Dr KG is a proctor for Edwards Lifesciences and is on the speaker’s bureau of Abbott.
Provenance and peer review Commissioned; internally peer reviewed.