AIMS Despite general agreement on the benefits of the Heart Team approach for patients with cardiac diseases, few data are available on its real impact on the decision-making process. The aim of the study is to define the evolution over time of the level of agreement with the systematic discussion of patients in the Heart Team and to evaluate the adherence to the Heart Team recommendations and the impact of the Heart Team on the clinical outcome of the patients. METHODS In 2015--2016, an experienced cardiac surgeon and a cardiologist independently reviewed clinical data of a series of 100 patients (Group 1, G1) and subsequently for each patient recommended treatment (surgical, percutaneous, hybrid or medical therapy) or further diagnostic investigations. The next day, each case was discussed by the Hospital Heart Team. The Heart Team recommendation, the subsequent treatment received by the patient and the in-hospital outcome were recorded. The same study procedure was repeated in 2017 in a second (G2) and in 2018 in a third (G3) group, both of them including 100 patients. RESULTS Complete agreement in treatment selection by the cardiac surgeon, cardiologist and the Heart Team was observed in 43% of cases in G1 and in 70% and 68% in G2 and G3, respectively (G1 vs. G2: P  < 0.001, G1 vs. G3: P  = 0.01, G2 vs. G3: P  = 0.30). Agreement was less frequent in patients with a higher risk profile and in patients with aortic valve stenosis. The Heart Team decision was implemented in 95% of cases with a 30-day mortality of 0.67%. CONCLUSION Agreement in treatment selection among the cardiac surgeon, cardiologist and Heart Team appears to be low in the initial experience. Subsequently, it seems to steadily increase over time up to a limit, when it reaches a plateau of stable results. Heart Team clinical cases discussion, based on both guidelines and multidisciplinary experience, represents a key step in defining the best patient treatment pathway, potentially improving the decision-making process and clinical results.

中文翻译：

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针对心血管疾病患者的多学科心脏团队方法：迈向个性化医疗的一步。

目的 尽管人们普遍认为心脏团队方法对心脏病患者有好处，但关于其对决策过程的真正影响的数据却很少。该研究的目的是确定心脏团队中患者系统讨论的一致性程度随时间的演变，并评估对心脏团队建议的遵守情况以及心脏团队对心脏团队临床结果的影响。患者。方法 2015--2016年，经验丰富的心脏外科医生和心脏病专家独立审查了一系列100名患者（第1组，G1）的临床数据，随后为每位患者推荐治疗（手术、经皮、混合或药物治疗）或进一步诊断调查。第二天，医院心脏团队对每个病例​​进行了讨论。记录心脏团队的建议、患者接受的后续治疗以及院内结果。2017 年第二组 (G2) 和 2018 年第三组 (G3) 重复了相同的研究程序，这两个组均包括 100 名患者。结果 心脏外科医生、心脏病专家和心脏团队在 G1 病例中的治疗选择完全一致，G1 病例中的比例为 43%，G2 和 G3 病例中的比例分别为 70% 和 68%（G1 与 G2：P < 0.001，G1 与 G2） G3：P = 0.01，G2 与 G3：P = 0.30）。在风险较高的患者和主动脉瓣狭窄患者中，达成一致的频率较低。心脏小组的决定在 95% 的病例中得到执行，30 天死亡率为 0.67%。结论 在最初的经验中，心脏外科医生、心脏病专家和心脏团队在治疗选择上的一致性似乎很低。随后，当它达到稳定结果的平台时，它似乎随着时间的推移稳步增加直至达到极限。心脏团队临床病例讨论基于指南和多学科经验，是确定最佳患者治疗途径的关键一步，有可能改善决策过程和临床结果。