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Is it time to refresh the heart team? New paradigms for shared decision making
  1. Julian Yeoh,
  2. Philip MacCarthy
  1. Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Professor Philip MacCarthy, Cardiology, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK; philip.maccarthy{at}nhs.net

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Learning objectives

  • Understand the evolution of the heart team for cardiovascular care, including the evidence for its development.

  • Understand the current advantages, challenges and disadvantages of the heart team and the limitations of the current model.

  • Appreciate the future direction of the heart team in order to meet the demands of a changing landscape of complex coronary and valvular heart disease.

Introduction

Traditionally composed of an interventional cardiologist, non-invasive cardiologist and a cardiac surgeon, the ‘heart team’ (HT), involves a multidisciplinary approach to decision making for cardiovascular patients. Following publication of the SYNTAX trial in 2009, this approach for coronary revascularisation has gained popularity.1 The concept has been incorporated into the European Society of Cardiology/European Association of Cardiothoracic Surgery (ESC/EACTS) and the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) Guidelines for Percutaneous Coronary Intervention as a Class I, Evidence Level C, recommendation, particularly for those with left main stem and complex coronary artery disease (CAD).2 3 It has now been widely adopted and expanded to include patients with aortic stenosis (AS) being considered for transcatheter aortic valve implantation (TAVI), many of whom have complex medical comorbidities. However, this HT concept continues to evolve beyond left main stem/triple vessel disease revascularisation and high-risk elderly patients with AS. It now has expanded to patients with CAD at high risk due to comorbidities/chronic coronary occlusions and valvular intervention beyond AS including ever-increasing subspecialty involvement. This article discusses the history and evolution of the HT and the paradigm shifts that have occurred along the way, analysing the advantages and challenges of such shared decision making. We debate the future direction of the HT and the evolution necessary to meet the demands of rapidly changing medical practice.

The origins of the HT

In 2009, the SYNTAX trial (percutaneous coronary intervention vs coronary-artery bypass grafting for severe …

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Footnotes

  • Twitter @JulianYeoh1

  • Contributors PM conceived the idea and advised on manuscript format, then edited and revised the text and figures. JY wrote the manuscript and revised the text and figures.

  • 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 PM is a procedural proctor for Edwards LifeSciences and has received Educational support from Edwards LifeSciences and research support from Boston Scientific.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article

  • Author note References which include a * are considered to be key references.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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