The Heart Team

The Heart Team is a relatively recent concept in modern cardiology. It refers to a multidisciplinary approach in which several heart specialists meet to evaluate together the best treatment strategy for a person with a complex heart condition.

This way of working is based on a simple idea: no single specialist has all the answers when several treatment options are possible.

Over the past twenty years, cardiology has undergone major changes.

Catheter-based procedures, performed using thin tubes inserted into bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels, have expanded considerably. These techniques now allow many heart conditions to be treated without the need for open-heart surgery.

Initially used mainly to treat narrowings in the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, these procedures have progressively evolved and can now address increasingly complex coronary disease.

The same is true for heart valve diseases and for certain interventions involving the structure of the heart. Procedures such as transcatheter valve replacement, valve repair, or closure of abnormal openings between heart chambers have become well-established treatment options.

With this growing variety of treatments — medications, catheter-based interventions, or cardiac surgery — choosing the most appropriate therapeutic strategy can become more complex.

It is precisely in this context that the concept of the Heart Team emerged.

Origine du concept

This multidisciplinary collaboration was gradually recognized in international cardiology guidelines in the early 2010s. Recommendations published by the European Society of Cardiology and the American College of Cardiology formally encouraged this type of collective discussion to guide certain complex treatment decisions.

This model first became widely adopted in two areas of cardiology where several treatment options may be considered:

complex coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease, when several coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that are affected and the choice between catheter-based intervention and surgery must be carefully evaluated
heart valve diseases, where different approaches — medical, interventional, or surgical — may be possible

Who is part of the Heart Team?

The Heart Team brings together different specialists who share their knowledge and experience in order to analyze a person’s condition and determine the most appropriate treatment approach.

Depending on the situation, the team may include a clinical cardiologist, an interventional cardiologist, a cardiac surgeon, a cardiac imaging specialist, a specialized nurse, or a care coordinator.

Depending on the complexity of the clinical situation, the team may also be expanded to include other professionals, such as:

an imaging specialist (radiologist or cardiologist)
an anesthesiologist
an oncologist
a social worker
a geriatrician
a physiotherapist
a pharmacist
a cardiologist specialized in heart failure or transplantation

In some centers, the discussion also includes the patient’s perspective, reflecting the modern concept of the patient partner.

Collaboration among these specialists allows for careful review of test results, the person’s overall health condition, associated medical problems, and personal preferences. The goal is to select the approach that offers the best balance between expected benefits and potential risks.

Today, the Heart Team has become a central element in the management of many complex heart conditions. This collaborative structure helps produce more thoughtful decisions that are better adapted to each situation while keeping the individual at the center of the decision-making process.

How does the Heart Team work?

The Heart Team usually meets during a structured discussion, sometimes referred to as a heart conference, valve conference, or complex case meeting.

During this meeting, the team reviews the person’s medical history as well as the results of the different tests performed. These may include, for example, echocardiography, coronary angiography, cardiac CT scanning, or cardiac magnetic resonance imaging (MRI).

The overall condition is also taken into account, including age and expected life expectancy, associated medical conditions, degree of frailty, how the heart and bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels are formed in each individual, as well as the impact of the disease on quality of life.

Each specialist then shares their perspective based on their area of expertise. The different treatment options are discussed together in order to evaluate their advantages and limitations.

This collective discussion helps determine the most appropriate strategy and supports the person in making an informed decision, taking into account both medical information and personal preferences — all with the goal of providing more individualized care.

A classic example: aortic stenosis

Aortic stenosis is one of the most common situations where the Heart Team approach plays an essential role.

This condition involves a narrowing of the aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >>, making it more difficult for the heart to pump bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood into the aorta and the rest of the body.

When the narrowing becomes severe and symptoms appear, replacing the valve usually becomes necessary.

Two main treatment approaches may then be considered.

The first is traditional cardiac surgery, which involves opening the chest in order to remove the diseased valve and replace it with a new one.

The type of valve must also be discussed. It may be a mechanical valve, which is very durable but requires lifelong anticoagulation therapy, or a biological valve, which usually does not require long-term anticoagulation but may have more limited durability over time.

The second option is a catheter-based procedure called transcatheter aortic valveThe aortic valve is located between the left ventricule and the aorta. It is one of the four valves ot the heart. >> replacement (TAVI). In this procedure, the new valve is delivered through a catheter, most often inserted through an artery in the leg, and then expanded inside the diseased valve without opening the chest.

Each option has advantages and limitations. Surgery offers a very durable repair but is more invasive. TAVI is less invasive and recovery is often faster, but it may not be the best option in every situation.

Several factors must therefore be carefully evaluated before making a decision: the risk associated with surgery, how the valve and the initial portion of the aorta (called the aortic root) are formed, including the location where the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that originate, the complexity of the path the new valve must travel through the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels — particularly those of the legs, neck, and arms — to reach the heart, the person’s age, as well as the presence of other medical conditions or other heart problems.

This is precisely where the Heart Team plays a crucial role. By bringing together different specialists, it becomes possible to carefully examine all available options and choose the approach best suited to the individual situation.

The advantages of the Heart Team

The Heart Team offers several advantages in medical decision-making.

Research has shown that when decisions are made collectively by several professionals acting in the patient’s best interest, outcomes are often better. This process allows a more comprehensive evaluation of treatment options and reduces the risk of decisions influenced by the perspective of a single specialty.

Discussion among experts also helps ensure better patient selection for certain interventions, and several studies have associated this collaborative structure with improved clinical outcomes.

For patients, this approach is often reassuring. Knowing that several specialists have carefully reviewed the situation and discussed all possible options increases confidence in the decision-making process.

Although this model is not entirely new, its use has expanded as medical technologies have become more advanced and complex. Similar multidisciplinary teams are also used in other areas of medicine, including cancer care, organ transplantation, and other complex medical conditions.

A natural evolution in medicine

For many years, medicine operated under a more paternalistic model, where a single physician determined the treatment to be offered.

Today, the management of cardiovascular diseases increasingly relies on collaboration among multiple specialists, collective analysis of medical data, and integration of the patient’s perspective in therapeutic decisions.

The Heart Team clearly illustrates this evolution toward a more collaborative, transparent, and patient-centered model of care.

In some centers, this approach may also include the participation of a patient partner within the team.

The lived experience of illness can provide valuable insight that enriches discussions and helps better address the realities, concerns, and expectations of those affected.