The Heart Team: Why Surgeons and Cardiologists Decide Together

If you have been told you need heart surgery, or that you might, the advice you receive can depend heavily on which specialist you happen to see first. A cardiac surgeon may favour surgery; an interventional cardiologist may favour a catheter-based procedure. That is not dishonesty — it is perspective. This is why modern guidelines recommend a heart team decision: a group of specialists from different disciplines who review your case together and agree on a single recommendation before anything is proposed to you. In this article, we explain what a heart team is, who sits on it, how the meeting actually works, and why this collaborative model tends to produce safer, more personalised choices for patients and their families.

What Is a Heart Team?

A heart team is a small, standing group of cardiac specialists — typically a cardiac surgeon, an interventional cardiologist, and often a clinical cardiologist and imaging specialist — who review complex heart cases together before any treatment is recommended. The concept became mainstream in cardiology around the time transcatheter aortic valve replacement (TAVR) was introduced, because choosing between surgical and catheter-based valve replacement was no longer a question one specialty could answer alone.

Why one opinion is not enough. The anatomy of the question matters: a surgeon judges how well a valve can be repaired or replaced through the chest, while a cardiologist judges how well the arteries, heart muscle and vessels will tolerate different approaches. A heart team decision puts both judgements on the table at the same time, so you receive one balanced recommendation rather than two competing ones.

What does it mean to be the heart of a team? In everyday language, being the "heart" of a team means being the person who holds it together. In cardiac medicine, the true heart of the team is the patient: every discussion, every guideline comparison and every imaging study is ultimately weighed against what you value — your recovery time, your travel, your family obligations. A team that forgets this has stopped being a heart team.

Our team is a multidisciplinary group of cardiac surgeons led by Dr Alejandro Molina, with consulting rooms in Guadalajara, Querétaro and Hermosillo, and every case is reviewed by the team against international practice guidelines before a recommendation is given.

How the Heart Team Approach Works in Cardiology

The heart team approach in cardiology is not a vague philosophy; it is a structured process. Each member sees the same data — your echocardiogram, your coronary angiogram, your CT scan, your history — and then the team meets to weigh the options against each other. The output is a written recommendation, usually accompanied by the alternatives that were considered and why they were set aside.

The sequence in practice. First, the referring cardiologist gathers the studies. Second, the team meets — often weekly — to review each case in turn. Third, the team's recommendation is communicated to the patient, along with what the alternatives would have meant. Nothing is decided until everyone who needs to speak has spoken.

Where the evidence supports this model. Medical societies on both sides of the Atlantic have embedded the heart team into treatment guidelines for coronary artery disease and valve disease, precisely because the choice between surgical and catheter-based treatment is no longer obvious. A heart team decision makes that trade-off explicit rather than accidental.

In our practice we encourage second opinions and treat seeking one as a normal part of deciding about heart surgery — the team's recommendation is always presented together with the alternatives, and the final decision is always yours.

Who Sits on a Multidisciplinary Cardiac Care Team?

A multidisciplinary cardiac care team is broader than most patients expect. It typically includes a cardiac surgeon (also called a cardiothoracic or cardiovascular surgeon, who operates on the heart, valves and aorta), an interventional cardiologist (who treats blockages and valves through catheters), and a clinical cardiologist who coordinates diagnosis and medical therapy.

Specialists you may not see at the table. Depending on the case, a structural cardiologist (a cardiologist trained in catheter-based valve procedures such as TAVR), a cardiac imaging specialist, an anaesthesiologist, and a nurse coordinator may all contribute. The composition changes with the problem; the principle does not: more than one discipline must agree before a recommendation is made.

Bridge to decision. Some teams use the phrase "bridge to decision" to describe a temporary support measure — such as a mechanical pump — used while the team decides whether the heart can recover or whether definitive treatment is needed. The point is that even in urgent situations, the decision is still made collectively, not by a single pair of hands.

Our work covers valve disease, coronary disease, the aorta and structural heart conditions, and we perform conventional, minimally invasive, robotic and transcatheter procedures — so our multidisciplinary team can genuinely weigh all of these options against each other for your case.

When a Heart Team Evaluation of Coronary Disease Matters

A heart team evaluation of coronary disease is most valuable when the treatment options genuinely diverge. Not every case needs a meeting: a single blocked artery treated with a stent, or a routine scenario, may be handled by the treating cardiologist directly. Complexity is what triggers the team.

Situations where the team is essential. The clearest examples include:

• Left main disease: narrowing of the artery that supplies most of the heart's blood, where stenting and bypass surgery are both legitimate options with different trade-offs.
• Multi-vessel disease: several arteries blocked, where the choice between bypass surgery and multiple stents depends on anatomy and patient condition.
• Reduced heart function: when the heart muscle is weak, the risk of each option changes and the team must weigh it carefully.

The aorta deserves its own mention. Acute intramural haematoma of the thoracic aorta — bleeding within the wall of the body's largest artery — is a case where the cardiologist and the cardiac surgeon must decide together whether the patient needs urgent surgery or careful medical monitoring, and the timing of that call can change the outcome. Research on this exact question has been published in Intramural haematoma of the thoracic aorta: who's to be alerted the cardiologist or the cardiac surgeon?, and it illustrates why the alert must go to both specialties at once.

When a patient comes to us with complex coronary disease, our team reviews the angiogram and the heart function together before recommending either bypass surgery or a less invasive route, and we recommend the less invasive route only where the evidence supports it for that patient.

Multidisciplinary Heart Valve Team Decisions

A multidisciplinary heart valve team is the clearest example of the heart team model in action. Valve disease — particularly aortic stenosis, the narrowing of the heart's main outflow valve — can now be treated by surgical valve replacement, minimally invasive surgery, or TAVR, a catheter procedure where a new valve is delivered through an artery in the groin.

What the team weighs. Age, the strength of the heart muscle, calcification and anatomy of the vessels, the presence of other valve disease, and the patient's own goals. A younger, active patient with a repairable mitral valve may be best served by surgery — and repair, when possible, is generally preferred over replacement. A frail, older patient with a heavily calcified aortic valve may be better served by TAVR.

Why surgery is not always "the big option". Many patients fear that any valve problem means open-chest surgery. In reality, the team's job is to find the lowest-risk option for your situation: sometimes that is a robotic or minimally invasive operation through small incisions, sometimes it is a transcatheter procedure, and sometimes it is medication and careful monitoring. None of these is universally better; they are better for different people.

Dr Molina trained in structural cardiology and TAVR at CHU Bordeaux in France, and in robotic and minimally invasive surgery at the University of Montreal, so our valve team can discuss both the surgical and the transcatheter path from first-hand experience.

Heart Team vs Single Doctor: What Changes for You

The heart team vs single doctor comparison is not about competence — a single excellent specialist can still be right. It is about bias. A surgeon sees problems through a surgical lens; a cardiologist through a catheter lens. Neither is wrong, but each is incomplete.

What changes practically. With a heart team, you will likely receive one written recommendation rather than conflicting verbal ones. Your questions will be answered by the person who actually specialises in the relevant procedure. The risks of each option — including the option of doing nothing — are laid out side by side.

What changes emotionally. Families often tell us that the hardest part of heart disease is not the treatment but the choosing. A heart team decision does not remove the choice from you, but it removes the pressure of having to referee between two doctors you trust. That is a quieter, calmer way to decide.

In the consultation we take the time to explain what the studies actually show, in plain words, and to answer every question before any decision is made.

What Happens in a Cardiac Team Case Discussion

A cardiac team case discussion follows a surprisingly predictable rhythm. The case is presented — often by the cardiologist who knows the patient — and the imaging is shown on a screen: the echocardiogram moving in real time, the angiogram, the CT scan. Then each specialist in turn gives their view, including the risks they see and the option they would favour.

Disagreement is part of the design. A good team meeting is not a chorus of agreement; it is a structured debate. When the surgeon and the interventional cardiologist disagree, the discussion turns to the specific features of this patient — the anatomy, the frailty, the goals — and the choice is resolved case by case rather than by habit or preference.

What the meeting produces. A consensus recommendation, documented in writing, with the reasoning and the alternatives. This is the document that follows the patient through their care, and it is what a second opinion should be compared against. Cardiac surgery training itself is evolving around this — the CAMERA study, published in Design and rationale of the artifiCiAl intelligence Model for Evaluating the surgical techniques of caRdiAc surgeons (CAMERA): a cohort study, is one example of how surgical technique is being examined with the same rigour the team brings to decisions.

Every case in our practice is reviewed by the multidisciplinary team against international practice guidelines before a recommendation is given, and the patient receives a clear proposal with the alternatives — the final decision is always theirs.

Heart Team Recommendation Letters and Shared Decision Making

Heart team recommendation letters are more than a formality. The letter should state the diagnosis, the studies reviewed, the options considered, the recommendation reached, and the reasoning behind it. If you receive a recommendation without the alternatives, ask for them — a proper letter includes them.

Shared decision making, defined. Shared decision making means the clinical team brings the evidence and the patient brings their values, and the choice is made together. This is different from the older model where a doctor simply instructed the patient. It is the standard the heart team model is built on, and it is especially important when the options carry genuinely different trade-offs — a longer recovery but a durable repair, versus a quicker recovery but a valve that may need revisiting sooner.

What to do with the letter. Read it, take it to a second opinion, and ask the second team whether they agree with the reasoning, not just the conclusion. A team confident in its recommendation welcomes this. A team that resists it is telling you something.

The first contact with our team is a free video consultation: we get to know the patient, talk through the condition, and say which studies are still needed so no unnecessary ones are ordered — a face-to-face visit at the consulting rooms follows when the patient decides to go ahead.

Team-Based Cardiac Care Planning and Your Second Opinion

Team-based cardiac care planning extends beyond the decision meeting. It covers the whole journey: which studies are needed and which are not, how the procedure will be done, what recovery will realistically look like, and how follow-up will be organised. Good planning prevents the two most common patient frustrations — unnecessary tests and unclear recovery timelines.

Avoiding unnecessary studies. A team that reviews your existing imaging before ordering new tests can often tell you what you already have. Ask whether your recent echocardiogram or CT scan can be reused. This saves money, time, and for many international patients, additional trips.

Recovery planning in plain terms. Conventional surgery through the breastbone usually means several days in hospital and weeks of sternal precautions — no lifting, no driving initially. Minimally invasive and robotic approaches typically shorten this, and TAVR often means the shortest stay of all. Your team should give you a realistic timeline for your specific procedure, not a generic one.

Dr Molina performed the first robotic mitral valve repair in the Ángeles Health System and the first robotic heart surgery in Guadalajara.

Is a Heart Team Decision Right for You?

A heart team decision is not a luxury reserved for rare cases; it is the standard of care for any complex heart problem. If you have been given a single opinion about valve disease, coronary disease, or the aorta, and you have not been told whether the alternatives were considered by a team, that is the question to ask.

Three questions worth asking any doctor.

• Was this reviewed by a multidisciplinary team? If not, ask why.
• What were the alternatives? A recommendation without alternatives is incomplete.
• What happens if I do nothing? Every option has a cost; the option of waiting does too.

Where to begin. If you or a family member has been diagnosed with a heart condition, the safest next step is a conversation with a qualified cardiac team — not a self-diagnosis, and not a rushed decision. A free initial video consultation with a heart team can clarify what your studies show, which studies are still missing, and which options genuinely fit your situation. You can then book a consultation with the team and take your time deciding. Our team led by Dr Alejandro Molina reviews every case together before recommending anything, and we will always tell you honestly when the less invasive route is — or is not — the right one for you.