A call for an evidence-based approach to the Heart Team for patients with severe aortic stenosis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• The Heart Team approach is a central concept in managing severe aortic stenosis, with Class I recommendations from major societies.
• It is a requirement for reimbursement for transcatheter aortic valve replacement (TAVR) in the United States.
• The rationale is to improve patient selection, procedural planning, and management for high-risk patients, ultimately enhancing outcomes.

Purpose of the Study:

• To define the Heart Team concept in severe aortic stenosis care.
• To review existing data supporting the effectiveness of the Heart Team approach.
• To highlight the need for clear definitions and shared metrics for optimal Heart Team implementation.

Main Methods:

• Literature review of Heart Team applications in severe aortic stenosis.
• Analysis of current professional society guidelines and reimbursement policies.
• Comparison with multidisciplinary team models in other specialties like oncology.

Main Results:

• While the Heart Team approach is widely adopted and recommended, a clear definition and robust supporting data are currently lacking.
• The multidisciplinary team model has precedent in other medical fields, such as oncology.
• There is a need for standardized definitions and outcome metrics.

Conclusions:

• The Heart Team approach is integral to modern severe aortic stenosis management.
• Further research is needed to establish clear definitions and evidence-based metrics for Heart Team effectiveness.
• Focusing on patient, clinician, and health system outcomes will advance understanding and optimization of this approach.