Is the Heart Team Approach Beneficial Dr. Gary P. Jones, MD, FACS LA CVT Institute, LLC
Team-Based Approach Already in Practice with Oncology Organ Transplant Programs
Rationale for Team-Based Care • Optimize the management of • Complex patient care issues • Patient groups at higher risks for adverse outcomes because of advanced age or comorbidities. • Care should be customized to the patients needs and that the patient should be the source of control • The Heart Team has potential Merit to satisfy above.
Heart Team Now • Class I Indication • 2010 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery Guidelines for Coronary Revascularization • 2012 ACC/AHA Guidelines for Coronary Artery Bypass Grafting Surgery
The Goalis to offer a balanced and complimentary approach to patient care by joint and shared decision-making among different medical care stakeholders such as Cardiac Surgery and Interventional Cardiology
The Goal (continued) This produces tailored recommendations for therapy for a more informed and engaged patient. Elevates the cognitive interchange that occurs among the specialties.
Importance of Heart Team in two areas- Coronary Revascularization- TAVR
Heart Team Coronary Revascularization PCI vs. CABG Trying to obtain optimal medical therapy for the patient.
Heart Team Coronary Revascularization • Sometimes straight-forward • ACS with isolated single discrete approachable coronary artery stenosis • Rx - PCI • Significant angina multiple coronary occlusions and other complex disease with adequate target vessels and viable myocardium • Rx - CABG
Heart Team Coronary Revascularization • Many RCTs • Syntax • Freedom • Excel • Ascert
Heart Team Coronary Revascularization • Registries for Clinical Trial – RCTs • Valuable • Have advantages and disadvantages • Discordance between these and “real world” registries • Uncommon for any single trial to provide the definitive answer for all patients • Each data set must be evaluated as part of the whole picture
Heart Team Coronary Revascularization • Members • Cardiac Surgeons • Interventional Cardiologists • Primary Cardiologists • They work together to focus on specific patient considerations and expectations.
Heart Team TAVR • Members • - Cardiac Surgeons • Interventional Cardiologists • A structural Heart disease Expert • An Imaging specialist • Mandated by US Food & Drug Administration and CMS
Heart Team TAVR Procedural performance improves when both Cardiac Surgeon and Interventional Cardiologist perform the procedure together.
Heart Team Implementation • Not without multiple potential issues and problems • Logistical standpoint • Gathering Heart Team participants • Establishing formats for interactions between the Heart Team will be essential.
Heart Team Implementation • Structural Heart Disease Center • Heart Team Members can meet • Print and Video for Patient and Family Education and for informed consent • Combined Medical and Surgical Conference held weekly
Heart Team Implementation Application of PCI at the time of diagnostic angiography in patients with complex or multiple vessel disease will become restricted.
Heart Team Implementation • Becoming not an option • Mandated in certain clinical situations by the Society guidelines and procedural reimbursement has been linked to it.
Heart Team Conclusion Heart Team – Central Role of - optimizing patient selection - procedural performance - follow-up care - enhancing patient education and informed consent
Heart Team Conclusion Composition of Heart Team will vary Logistical blockades will have to be overcome Heart Team Concept will form the Heart of Modern Cardiovascular Care
Thank you. Gary P. Jones, MD, FACS LA CVT Institute, LLC