What is Heart team approach?
Heart team approach as currently encouraged by most hospitals boils down to obtaining the approval of the cardiac surgeon before an interventional cardiologist may embark upon a Complex PCI/Stent procedure in lieu of open heart surgery.
In the past, one of the reasons such an approach was deemed necessary was because there existed a small but finite chance that emergency open heart surgery could become necessary during the stenting procedure.
However, with the rapid evolution of PCI/Coronary stenting as a safe and effective non surgical technique for myocardial revascularization the need for surgical backup has markedly diminished; in other words it is uncommon that a patient undergoing a protected PCI will end up requiring emergency open heart surgery.
Interestingly, there is an evolving role of emergency Coronary stenting/PCI in the immediate post CABG/OHS patient to prevent serious complications arising from early failure of bypass grafts as recently reported in the Journal of American College of cardiology.
As such, based on supporting scientific data establishing equipoise between surgery and PCI for the treatment of most non diabetic patients with complex coronary artery disease, it is the opinion of this site that the Heart Team approach concept as currently practiced needs an update.
NOCOBYE™ believes that in all intellectual honestly it may now be time for a “BALANCED HEART TEAM APPROACH”.
In other words any patient advised CABG/Open heart surgery should at least also be educated about and offered the relatively comparable nonsurgical catheter based treatment options, namely coronary stenting/PCI.