Abstract
The concept of multidisciplinary teams has been adopted in the medical field to varying degrees depending on specialties. The idea that an individual physician has all the necessary knowledge and experience and is expected to decide on ever more complex medical issues where more than one treatment option is available is archaic, and can no longer be the norm. As patients become more informed, be it through accurate sources or not, it becomes even more important for decisions to be unbiased by individual physicians. It should also be reassuring to the patient that details of his or her care have been discussed at a cross-speciality meeting and alternatives have been brought to the table so that optimal care has been recommended by a team. Some would argue that there is currently no robust data to enforce a multidisciplinary approach for coronary revascularization, but it has been the pillar of several large clinical trials and is a practice that is recommended by panels of experts within cardiac societies. The obstacles and potential benefits of a so-called Revascularization Heart Team are discussed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69(17):2212–41.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165.
Schwalm JD, Wijeysundera HC, Tu JV, Guo H, Kingsbury KJ, Natarajan MK. Influence of coronary anatomy and SYNTAX score on the variations in revascularization strategies for patients with multivessel disease. Can J Cardiol. 2014;30(10):1155–61.
Toyota T, Morimoto T, Shiomi H, Ando K, Ono K, Shizuta S, et al. Ad hoc vs. non-ad hoc percutaneous coronary intervention strategies in patients with stable coronary artery disease. Circ J. 2017;81(4):458–67.
Hannan EL, Racz MJ, Gold J, Cozzens K, Stamato NJ, Powell T, et al. Adherence of catheterization laboratory cardiologists to American College of Cardiology/American Heart Association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery: what happens in actual practice? Circulation. 2010;121(2):267–75.
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219–27.
Garot P, Tafflet M, Kumar S, Salvatella N, Darremont O, Jouven X, et al. Reproducibility and factors influencing the assessment of the SYNTAX score in the left main Xience study. Catheter Cardiovasc Interv. 2012;80(2):231–7.
Genereux P, Palmerini T, Caixeta A, Cristea E, Mehran R, Sanchez R, et al. SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements. Circ Cardiovasc Interv. 2011;4(6):553–61.
Tanboga IH, Ekinci M, Isik T, Kurt M, Kaya A, Sevimli S. Reproducibility of syntax score: from core lab to real world. J Interv Cardiol. 2011;24(4):302–6.
Shiomi H, Tamura T, Niki S, Tada T, Tazaki J, Toma M, et al. Inter- and intra-observer variability for assessment of the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score and association of the SYNTAX score with clinical outcome in patients undergoing unprotected left main stenting in the real world. Circ J. 2011;75(5):1130–7.
Garg S, Girasis C, Sarno G, Goedhart D, Morel MA, Garcia-Garcia HM, et al. The SYNTAX score revisited: a reassessment of the SYNTAX score reproducibility. Catheter Cardiovasc Interv. 2010;75(6):946–52.
Banning AP, Baumbach A, Blackman D, Curzen N, Devadathan S, Fraser D, et al. Percutaneous coronary intervention in the UK: recommendations for good practice 2015. Heart. 2015;101(Suppl 3):1–13.
Al-Lamee R, Thompson D, Dehbi HM, Sen S, Tang K, Davies J, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018;391(10115):31–40.
Denvir MA, Pell JP, Lee AJ, Rysdale J, Prescott RJ, Eteiba H, et al. Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams? J Cardiothorac Surg. 2006;1:2.
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):594–8.
Pavlidis AN, Perera D, Karamasis GV, Bapat V, Young C, Clapp BR, et al. Implementation and consistency of heart team decision-making in complex coronary revascularisation. Int J Cardiol. 2016;206:37–41.
Brener SJ, Alapati V, Chan D, Da-Wariboko A, Kaid Y, Latyshev Y, et al. The SYNTAX II score predicts mortality at 4 years in patients undergoing percutaneous coronary intervention. J Invasive Cardiol. 2018;30(8):290–4.
Escaned J, Banning A, Farooq V, Echavarria-Pinto M, Onuma Y, Ryan N, et al. Rationale and design of the SYNTAX II trial evaluating the short to long-term outcomes of state-of-the-art percutaneous coronary revascularisation in patients with de novo three-vessel disease. EuroIntervention. 2016;12(2):e224–34.
Escaned J, Collet C, Ryan N, De Maria GL, Walsh S, Sabate M, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J. 2017;38(42):3124–34.
Modolo R, Collet C, Onuma Y, Serruys PW. SYNTAX II and SYNTAX III trials: what is the take home message for surgeons? Ann Cardiothorac Surg. 2018;7(4):470–82.
Cavalcante R, Onuma Y, Sotomi Y, Collet C, Thomsen B, Rogers C, et al. Non-invasive heart team assessment of multivessel coronary disease with coronary computed tomography angiography based on SYNTAX score II treatment recommendations: design and rationale of the randomised SYNTAX III revolution trial. EuroIntervention. 2017;12(16):2001–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Chong, AY., Meadows, T., Glineur, D. (2019). Complex Coronary Revascularization Heart Team. In: Mesana, T. (eds) Heart Teams for Treatment of Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-19124-5_2
Download citation
DOI: https://doi.org/10.1007/978-3-030-19124-5_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-19123-8
Online ISBN: 978-3-030-19124-5
eBook Packages: MedicineMedicine (R0)