Is it time to refresh the heart team? New paradigms for shared decision making

### Learning objectives Traditionally composed of an interventional cardiologist, non-invasive cardiologist and a cardiac surgeon, the ‘heart team’ (HT), involves a multidisciplinary approach to decision making for cardiovascular patients. Following publication of the SYNTAX trial in 2009, this approach for coronary revascularisation has gained popularity.1 The concept has been incorporated into the European Society of Cardiology/European Association of Cardiothoracic Surgery (ESC/EACTS) and the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) Guidelines for Percutaneous Coronary Intervention as a Class I, Evidence Level C, recommendation, particularly for those with left main stem and complex coronary artery disease (CAD).2 3 It has now been widely adopted and expanded to include patients with aortic stenosis (AS) being considered for transcatheter aortic valve implantation (TAVI), many of whom have complex medical comorbidities. However, this HT concept continues to evolve beyond left main stem/triple vessel disease revascularisation and high-risk elderly patients with AS. It now has expanded to patients with CAD at high risk due to comorbidities/chronic coronary occlusions and valvular intervention beyond AS including ever-increasing subspecialty involvement. This article discusses the history and evolution of the HT and the paradigm shifts that have occurred along the way, analysing the advantages and challenges of such shared decision making. We debate the future direction of the HT and the evolution necessary to meet the demands of rapidly changing medical practice. In 2009, the SYNTAX trial (percutaneous coronary intervention vs coronary-artery bypass grafting for severe …