Japanese College of Angiology

There is increasing recognition of the importance of the heart team in optimising decision making for patients who require interventions. This approach is now the standard of care for patients requiring percutaneous valve replacement and there is broad agreement on this issue between interventional cardiologists and cardiac surgeons. In contrast, although the ESC/EACTS and ACC/AHA, recommend(IC) a Heart team Approach for patients with complex coronary artery disease there is less evidence that this occurs in practice. Indeed, although there is a considerable body of evidence to suggest that coronary artery bypass grafting is the optimum choice for revascularisation in patients with complex coronary artery disease, many institutions and countries have not widely adopted the heart team approach. This is reflected in major variations in the rates and ratios of stenting to CABG both between countries and within countries with similar medical and economic climates. The question of whether the heart team should be mandatory and whether only interventions agreed by the heart team should be reimbursed or be discussed.