Abstract 341: The Revascularization Heart Team: Feasibility and Cross-sectional Patient Profile in a Large Academic Center

Abstract

The American College of Cardiology guidelines assign a Class IC recommendation for the use of a Heart Team approach in the treatment of complex coronary artery disease (CAD). However, doubts remain regarding the practical application and functionality of this method in providing routine cardiovascular care. We sought to assess the feasibility of the Heart Team approach to adjudicate complex CAD through analyzing personnel participation, as well as anatomic and comorbid patient characteristics. From May to October, 2012 we convened a daily Heart Team meeting to discuss evidence based management of patients with complex CAD. All cases were comprehensively reviewed by a team of interventional cardiologists, non-invasive cardiologists, cardiac surgeons, and anesthesiologists within 72 hours of angiography in our health system. Meetings occurred on average 3.5 days per week and included an average of 4 physicians from the multidisciplinary team. Patient profiles are detailed in Table 1. Recommendations for treatment were made based on a consensus decision amongst the group, and ultimately 20% of patients received medical therapy, 26.4% underwent percutaneous coronary intervention (PCI), 38.2 % had coronary bypass with or without valve repair or replacement, 0.9% went for minimally invasive direct coronary artery bypass, and 2.7% were treated with a hybrid procedure including PCI followed by surgery. We found a structured Heart Team approach to be feasible, and effective in formulating revascularization strategies for individual patients. This represents a successful model for the implementation of the Heart Team in routine care, which has great potential to positively influence quality of care. Further analyses are being explored to evaluate the impact of the Heart Team on patient outcomes.