Abdulrahman Mohamed, Alsabbagh Alaa, Kuntze Thomas, Lauer Bernward, Ohlow Marc A
Division of Cardiology, Zentralklinik, Bad Berka 99437, Germany.
Division of Cardiovascular Surgery, Zentralklinik, Bad Berka 99437, Germany.
J Clin Med. 2019 Sep 19;8(9):1490. doi: 10.3390/jcm8091490.
The Heart Team (HT) discussion has been incorporated in the current guidelines for myocardial revascularization in order to optimize treatment decisions for patients with multivessel coronary disease (MVD). There are no data in the literature, whether hierarchical issues do have an impact on HT decisions. We aimed to analyze the therapeutic recommendations of the multidisciplinary "Heart Team" (HT) for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) if: (a) The head of cardiovascular surgery (HOS) and the head of cardiology (HOC) were present during the HT meeting, (b) both directors were absent, (c) only HOS or HOC was present. Retrospective analysis of all HT discussions between 2012 and 2015 in patients with isolated MVD (without any other cardiac problems requiring surgery). During the study period, we analyzed 209 HT discussions in patients with isolated MVD. If neither HOS nor HOC was present at the HT discussion, the therapeutic recommendation was in 69% CABG and 31% PCI. If HOS and HOC were present in 77% CABG and 23% PCI was recommended ( = 0.34). If only HOS was present therapeutic recommendation was in 83% CABG and 17% PCI, and if only HOC was present the recommendation was in 54% CABG and 46% PCI ( < 0.0001). This difference did not attenuate during the study period. The hierarchy of the participating physicians significantly impacts treatment recommendations of a multidisciplinary HT in patients with isolated MVD. This impact did not attenuate after several years of Heart Team interaction.
心脏团队（HT）讨论已被纳入当前的心肌血运重建指南，以优化多支冠状动脉疾病（MVD）患者的治疗决策。文献中没有数据表明层级问题是否会对心脏团队的决策产生影响。我们旨在分析多学科“心脏团队”（HT）对于冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的治疗建议，条件如下：（a）心血管外科主任（HOS）和心脏病学主任（HOC）出席HT会议；（b）两位主任均缺席；（c）仅HOS或HOC出席。对2012年至2015年期间孤立性MVD患者（无其他需要手术的心脏问题）的所有HT讨论进行回顾性分析。在研究期间，我们分析了209例孤立性MVD患者的HT讨论。如果HT讨论时HOS和HOC均未出席，治疗建议为69%行CABG，31%行PCI。如果HOS和HOC出席，77%建议行CABG，23%建议行PCI（P = 0.34）。如果仅HOS出席，治疗建议为83%行CABG，17%行PCI；如果仅HOC出席，建议为54%行CABG，46%行PCI（P < 0.0001）。在研究期间这种差异并未减弱。参与讨论的医生层级对孤立性MVD患者多学科心脏团队的治疗建议有显著影响。经过数年的心脏团队互动，这种影响并未减弱。
