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The Impact of Heart Team Discussion on Decision Making for Coronary Revascularization in Patients with Complex Coronary Artery Disease
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  • Louise Kezerle,
  • Eli Yohanan,
  • Avshalom Cohen,
  • Miri Merkin,
  • Yaron Ishay,
  • Jean Marc Weinstein,
  • Carlos Cafri
Louise Kezerle
Soroka University Medical Center
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Eli Yohanan
Ben-Gurion University of the Negev
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Avshalom Cohen
Clalit Health Services
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Miri Merkin
Soroka University Medical Center
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Yaron Ishay
Soroka University Medical Center
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Jean Marc Weinstein
Soroka University Medical Center
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Carlos Cafri
Soroka University Medical Center
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Abstract

Background and aim: Revascularization guidelines support routine heart team (HT) discussion of appropriate patients. The effect of HT on decision making and clinical outcomes hasn’t been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods: We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease referred for HT discussion between 2016-2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005-2015 (No HT group). Results: There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery (STS) score (2.5± 3 vs. 3 ±3 p=0.32) and the mean SYNTAX score was low and similar in both groups (21±6 vs. 19±6 p=0.59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the no HT group (p<0.01). HT discussion led to a significant delay to PCI (8±5 vs. 1.8±4 days, p=0.02), while surgical revascularization times were not affected. Conclusion: HT discussion in patients with multivessel CAD was associated with an increased referral to CABG but led to a significant delay in revascularization by angioplasty. The impact of these findings on patient satisfaction and outcome should be further investigated.

Peer review status:Published

01 Jun 2020Submitted to Journal of Cardiac Surgery
01 Jun 2020Submission Checks Completed
01 Jun 2020Assigned to Editor
01 Jun 2020Reviewer(s) Assigned
13 Jun 2020Review(s) Completed, Editorial Evaluation Pending
15 Jun 2020Editorial Decision: Revise Major
19 Jun 20201st Revision Received
20 Jun 2020Submission Checks Completed
20 Jun 2020Assigned to Editor
22 Jun 2020Reviewer(s) Assigned
12 Jul 2020Review(s) Completed, Editorial Evaluation Pending
15 Jul 2020Editorial Decision: Accept
Oct 2020Published in Journal of Cardiac Surgery volume 35 issue 10 on pages 2719-2724. 10.1111/jocs.14892