Although the Heart Team approach receives the highest level of recommendation (I) it only receives a C level of evidence because heart team decision making needs to be the object of randomised controlled trials: data on heart teams for patients with CAD should build in the next few years. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 0000016281 00000 n ", Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Arrhythmias, Keywords: Physicians, Patient Care, Thoracic Surgery, Patient-Centered Care, Complement System Proteins, Patient Selection, Myocardial Revascularization, Medicine, Cardiovascular Diseases, Coronary Artery Bypass, United States. The data, analytical methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure without previous approval from the National Health Service Health Research Authority. We have previously reported implementation and consistency of an HT approach in a single, large academic center.7 However, there remains a paucity of data in regard to hard clinical end points following HT discussion. Additional relevant clinical data, functional status, and patient characteristics were incorporated in the final decision making when determining optimal mode of treatment. 1-800-AHA-USA-1 The ACC/AHA guidelines define a Heart Team as A multidisciplinary team of an interventional cardiologist and a cardiac surgeon who jointly: Review the patient's medical condition and coronary anatomy Determine that PCI and/or CABG are technically feasible and reasonable It’s also up to you to tell them how you're doing. 0000012238 00000 n Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. Monday - Friday: 7AM - 9PM CST In our experience, the HT approach involved a careful selection process resulting in appropriate patient‐specific decision making with good clinical outcomes in patients with complex CAD. Vahanian A, Alfieri O, Andreotti F, et al. 0000005911 00000 n This has now been codified in guideline documents, and the Heart Team has emerged as a class 1 indication in both the 2010 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery Guidelines for Coronary Revascularization and the 2012 ACC/AHA Guidelines for Coronary Artery Bypass Grafting surgery . In patients with complex CAD following HT discussion and implementation, 30‐day, 1‐, and 3‐year outcomes in addition to the distribution of baseline characteristics (age, sex, body mass index, previous myocardial infarction, previous PCI, previous CABG, diabetes mellitus, hypertension, hypercholesterolemia, smoking history, chronic kidney disease [CKD], peripheral vascular disease (PVD), LV dysfunction, extent of coronary disease (including left main stem disease), unstable presentation, cardiogenic shock, SYNTAX score, Canadian Cardiac Society, and NYHA class were examined. Guidelines on myocardial revascularizationWilliam Wijns, Philippe Kolh et al. Figure 1. From April 2012 to April 2013, 51 HT meetings were held and a total of 398 cases were discussed. 2013 Feb 23;381(9867):639-5017. Shahian DM et al. endstream endobj 104 0 obj [130 0 R] endobj 105 0 obj <>stream Table 1 displays baseline characteristics, including cardiovascular risk factors, extent of coronary disease (1‐, 2‐, or 3‐vessel), SYNTAX scores, and clinical presentation in the overall cohort and according to final allocated treatment strategy. Survival at 3 years was 60.8% (84 of 137) in the OMT cohort, 84.3% (107 of 127) in the PCI cohort, and 90.2% in the CABG cohort (92 of 102). R�hS��D��$��&� 0000001831 00000 n disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. Circulation. Many years ago, when options were limited to either medical or surgical, clinical decisions were relatively simpler and the Heart Team was smaller and more cohesive," said ACC President William Zoghbi, MD, FACC, who was one of the authors of the paper.
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