Table 1.
Heart Team approach recommendations through the ESC Guidelines referring to coronary artery diseases.
| 2013 ESC Guidelines on the management of stable coronary artery disease | LOE | |
| Indications for revascularization of stable CAD patients on optimal medical therapy (adapted from ESC/EACTS 2010 Guidelines) | A Heart Team approach to revascularization is recommended in patients with unprotected LM, 2-3 vessel disease, diabetes, or comorbidities | IC |
|
| ||
| 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation | ||
| Recommendations for perioperative management of antiplatelet therapy in non-ST-elevation acute coronary syndrome patients requiring CABG | It is recommended that the Heart Team estimates the individual bleeding and ischaemic risks and guides the timing of CABG as well as management of DAPT | IC |
| Recommendations for invasive coronary angiography and revascularization in non-ST-elevation acute coronary syndrome | In patients with multivessel CAD, it is recommended to base the revascularization strategy (e.g., ad hoc culprit-lesion PCI, multivessel PCI, and CABG) on the clinical status and comorbidities as well as the disease severity (including distribution, angiographic lesion characteristics, and SYNTAX score), according to the local Heart Team protocol | IC |
| Recommendations for the management of patients with acute heart failure in the setting of non-ST-elevation acute coronary syndromes | It is recommended that patients with mechanical complications of NSTEACS are immediately discussed by the Heart Team | IC |
|
| ||
| 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS | ||
| Recommendations for catheter ablation of atrial fibrillation and atrial fibrillation surgery | Minimally invasive surgery with epicardial pulmonary vein isolation should be considered in patients with symptomatic AF when catheter ablation has failed. Decisions on such patients should be supported by an AF Heart Team | IIaB |
| Maze surgery, possibly via a minimally invasive approach, performed by an adequately trained operator in an experienced center, should be considered by an AF Heart Team as a treatment option for patients with symptomatic refractory persistent AF or postablation AF to improve symptoms | IIaC | |
|
| ||
| 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS | ||
| DAPT in patients treated with cardiac surgery with stable or unstable CAD | It is recommended that the Heart Team estimates the individual bleeding and ischaemic risks and guides the timing of CABG as well as the antithrombotic management | IC |
|
| ||
| 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation | ||
| Recommendations for the management of cardiogenic shock in ST-elevation myocardial infarction | It is indicated that mechanical complications are treated as early as possible after discussion by the Heart Team | IC |
|
| ||
| 2017 ESC/EACTS Guidelines for the management of valvular heart disease | ||
| Indications for surgery in (A) severe aortic regurgitation and (B) aortic root disease (irrespective of the severity of aortic regurgitation) | Heart Team discussion is recommended in selected patients in whom aortic valve repair may be a feasible alternative to valve replacement | IC |
| Indications for intervention in aortic stenosis and recommendations for the choice of intervention mode | Aortic valve interventions should only be performed in centres with both departments of cardiology and cardiac surgery on-site and with structured collaboration between the two, including a Heart Team (heart valve centres) | IC |
| TAVI is recommended in patients who are not suitable for SAVR as assessed by the Heart Team | IB | |
| In patients who are at increased surgical risk (STS or EuroSCORE II>_4% or logistic EuroSCORE I>_10% or other risk factors not included in these scores such as frailty, porcelain aorta, and sequelae of chest radiation), the decision between SAVR and TAVI should be made by the Heart Team according to the individual patient characteristics, with TAVI being favoured in elderly patients suitable for transfemoral access | IB | |
| SAVR should be considered in patients with moderate aortic stenosis undergoing CABG or surgery of the ascending aorta or of another valve after Heart Team decision | IIaC | |
| Indications for intervention in severe primary mitral regurgitation | Percutaneous edge-to-edge procedure may be considered in patients with symptomatic severe primary mitral regurgitation who fulfil the echocardiographic criteria of eligibility and are judged inoperable or at high surgical risk by the Heart Team, avoiding futility | IIbC |
| Indications for mitral valve intervention in chronic secondary mitral regurgitation | In patients with severe secondary mitral regurgitation and LVEF <30% who remain symptomatic despite optimal medical management (including CRT if indicated) and who have no option for revascularization, the Heart Team may consider a percutaneous edge-to-edge procedure or valve surgery after careful evaluation for a ventricular assist device or heart transplant according to individual patient characteristics | IIbC |
| Management of prosthetic valve dysfunction—haemolysis and paravalvular leak | Transcatheter closure may be considered for paravalvular leaks with clinically significant regurgitation in surgical high-risk patients (Heart Team decision). | IIbC |
| Management of prosthetic valve dysfunction—bioprosthetic failure | Transcatheter valve-in-valve implantation in the aortic position should be considered by the Heart Team depending on the risk of reoperation and the type and size of prosthesis | IIaC |
|
| ||
| 2018 ESC/EACTS Guidelines on myocardial revascularization | ||
| Recommendations for decision-making and patient information in the elective setting | It is recommended that institutional protocols are developed by the Heart Team to implement the appropriate revascularization strategy in accordance with current guidelines | IC |
| Recommendations on revascularization in patients with chronic heart failure and systolic left ventricular dysfunction (ejection fraction < 35%) | In patients with three-vessel disease, PCI should be considered based on the evaluation by the Heart Team of the patient's coronary anatomy, the expected completeness of revascularization, diabetes status, and comorbidities | IIaC |
| Recommendations for the management of patients with cardiogenic shock | In cases of haemodynamic instability, emergency surgical or catheter-based repair of mechanical complications of ACS is indicated, as decided by the Heart Team | IC |
| Recommendations on repeat revascularization—early postoperative ischaemia and graft failure | It is recommended that either emergency reoperation or PCI is decided upon by ad hoc consultation in the Heart Team, based on the feasibility of revascularization, area at risk, comorbidities, and clinical status | IC |
| Recommendations on repeat revascularization—restenosis | In patients with recurrent episodes of diffuse in-stent restenosis, CABG should be considered by the Heart Team over a new PCI attempt | IIaC |
| DAPT in patients undergoing cardiac surgery | It is recommended that the Heart Team estimates the individual bleeding and ischaemic risks and guides the timing of CABG as well as the antithrombotic management | IC |
CAD: coronary artery disease; LM: left main; CABG: coronary artery bypass grafting; DAPT: dual antiplatelet therapy; PCI: percutaneous coronary intervention.