The evidence: Cardiac surgery or interventional procedure?

The title of the talk is emblematic of the binary way that we have approached structural heart disease where cardiac surgery or an interventional procedure might be required – this thinking is now transitioning to an entirely different paradigm which is that of the "Heart Team".  Remarkable advances over the last decade have led to a plethora of interventional options for both coronary and structural heart disease. In the coronary realm, as complex and high risk PCI options continue to evolve, the role for surgery in multi-vessel disease, diabetes and LV dysfunction has become well established. Hybrid revascularization options also evolve and are the subject of ongoing investigation. In structural heart disease, as TAVR application expands to a low risk subset, ongoing investigations will answer questions regarding durability of TAVR as compared to the historical surgical gold standard. Mitral valve repair remains the gold standard for degenerative MR and the Mitraclip has become a well-established option for a high-risk subset. Ongoing studies will answer the role of Mitraclip in functional MR and excitingly multicenter studies are investigating a role for transcatheter mitral valve replacement for mitral valve disease. The role of surgery in tricuspid valve disease, a large and underserved subset remains controversial and transcatheter devices remain investigational at this point. The reality is that decision-making is complex and central to the entire debate is the heart team concept, whereby surgeons and interventionalists sit at the same table as part of the same team to determine the best approach for any given patient. As evidence continues to evolve, lines between cardiac surgery and interventional cardiology continue to blur, with combined expertise from both sides going forward required to best serve our patients in a truly heart team approach.