The heart team: the multidisciplinary approach to coronary artery disease

Figures

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  Figure 1.. The “Five Star” model, adapted from Lee et al., is depicted here and has five steps to operationalizing a heart team[41]. These steps are intended for broad use to guide the formation of an effective heart team.

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  Figure 2.. Evolution of the Heart Team: the heart team has evolved from a core group of members, which typically included an interventional cardiologist, cardiac surgeon, and the referring cardiologist or other physician. Current multidisciplinary heart teams may include additional medical and surgical consultants, specialized cardiologists, such as heart failure and echocardiography, intensivists, advanced practice providers (APP’s), clinical pharmacists, nutritionists, social workers, and others as needed to provide a more holistic, patient-centered approach to the decision-making process.

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  Figure 3.. Coronary angiogram images of a 75-year-old man with a history of STEMI and PCI to RCA, LAD, and LCF who presented with angina and was discussed by a Heart Team (Patient #2). (A) representative image of the right coronary artery showing several areas of distal stenoses (yellow arrows). (B) A representative image of the left coronary arteries and in-stent restenosis of the LAD (yellow arrow). STEMI: ST elevation myocardial infarction; PCI: percutaneous intervention; RCA: right coronary artery; LAD: left anterior descending; LCF: left circumflex.

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  Figure 4.. Coronary angiogram of a 71-year-old male with a history of AVR and MVr complicated by sternal wound infection and closure with titanium plates and screws and pectoralis muscle flaps who presented with severe AS, severe MS, and CAD and was discussed by a Heart Team (Patient #3). A representative image demonstrates significant stenosis in the proximal RCA (yellow arrow), contrast in the ascending aorta, sternal plates and screws, and bioprosthetic aortic valve. AVR: Aortic valve replacement; MVr: mitral valve repair; AS: aortic stenosis; MS: mitral stenosis; CAD: coronary artery disease; RCA: right coronary artery.