Heart Team: from recommendation to responsibility

Heart Team has evolved from an innovative concept back in SYNTAX trial, up to being endorsed throughout coronary revascularization and valvular heart disease guidelines. Yet, a clear operational definition and standardized implementation remain vague, with substantial variability between and within healthcare systems. While the multidisciplinary composition of the team forms its structural cornerstone, its effectiveness ultimately depends on integrating clinical evidence with confounding factors such as socioeconomic status, health literacy, social support, and geographic access to care. At a large percentage, discussions are informal, poorly documented, and vulnerable to institutional or procedural bias, while patient participation stays limited and decision quality is rarely audited. This viewpoint contemplates that comprehensive documentation, meaningful patient engagement, explicit consideration of access-to-care barriers, and external auditing should become minimum standards. Evidence-based medicine must be balanced with context-based medicine in order for the Heart Team to deliver equitable, patient-centred care.