Approaches to the Role of The Heart Team in Therapeutic Decision Making for Heart Valve Disease

Multidisciplinary decision making is becoming increasingly important in health care with ever growing therapeutic options available in complex cases. This is also true for cardiovascular medicine, where the introduction of percutaneous coronary intervention caused a revolution in the treatment of coronary artery disease. Currently, with the development of transcatheter procedures to repair or replace heart valves, the treatment of valvular heart disease is subject to a similar transition. Especially the treatment of severe aortic stenosis in high- and intermediate-surgical-risk patients has changed significantly, with the emergence of the transcatheter aortic valve replacement (TAVR) as an accepted treatment. In order to oversee the extensive set of diagnostic and therapeutic options it is suggested that decision making is performed in a multidisciplinary team, i.e. a Heart Team. This review gives a summary of the changes that have taken place and continue to take place in the treatment of aortic, tricuspid and mitral valve disease. Furthermore, an overview is provided of the advantages and limitations of shared decision making. Three possible models of decision making in the treatment of patients with severe aortic stenosis are discussed in detail. Subsequently, surgical risk scores, the assessment of frailty in possible TAVR candidates and the necessity of Heart Team reimbursement are discussed.