Abstract

The European Society of Cardiology recommends involvement of a Heart Team in the decision-making process of complex cardiac diseases. The term „complex cardiac disease“ refers to cases in which an interventional cardiologist decides not to solve the problem with an ad hoc PCI (i. e. solving it during the procedure of diagnostic invasive coronarography), but refers the patient for
multidisciplinary consultation involving cardiac surgeons, interventional cardiologists, clinical cardiologists, functional cardiologists, treating physicians and, if needed, other specialists, i.e. setting up a Heart Team. At Tartu University Hospital, such a team has acted since 2002 and between 2009 and 2018 they consulted a total of 3,056 cases, of which 69% involved male patients with a mean age of 68 years and 31% involved female patients with a mean age of 72 years. Mostly they consulted CAD patients for the best revascularisation method. As the results of the current research suggest, CABG was the main decision (44.3% of all decisions) made by the Heart Team, followed by pharmacological therapy (18.2%) and PCI (15.1%). A smaller proportion of the cases involved valvular disease. Sometimes the decision required further functional testing and/or confirming clinically significant ischemia or valvular pathology or some other cardiac
disease. However, not all decisions were put into practice. Approximately 6% of all decisions in 2009 – 2018 were not realised. In most cases the reason is unknown since there is no relevant information in the electronic case history (eHL) database. We also found that the mean surgical risk score Euroscore II for the patients discussed by the Heart Team was 2.8%; in the cases of
CABG (incl. CABG + surgical valve replacement), PCI and pharmacotherapy it was 2.1%, 3.1% and 3.5%, respectively. All in all, Tartu University Hospital’s Heart Team provides an optimised way for offering patients with complex cardiac disease the best individual treatment.