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Post Syntax Trial, ‘Heart Team’ Concept has been ensconsed class I recommendation in both the European and ACC/AHA guidelines and has gained increasing traction in context of complex and multi modality procedures. Despite an arrray of advantages including the much touted - ‘the patient is central’, there are a plethora of un-addressed issues, some of which sentinel to our country, which threaten to make the ‘Heart Team’ concept a perfunctory exercise. As it stands today, ‘Heart Team’ is more of a fictional euphemism, a kind of 'Platonic Illusion' rather than a pragmatic reality.

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Routine preoperative Doppler screening of the radial artery in the setting of limited resources is not justified. On the other hand, the time-tested Allen test which is easy to perform, interpret, and reproduce can be safely used as the sole screening test to harvest the radial artery.

Patients undergoing cardiovascular and thoracic procedures are at an accentuated risk of higher morbidity and mortality, which are a consequence of the proliferative nature of the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) on the lung vasculature, which in turn reflects as a cascading effect on the interdependent physiology of the cardiovascular and pulmonary organ systems. These are secondary to systemic inflammatory response syndrome and immunosuppressive responses to surgery and mechanical ventilation. Thus, the need to establish guidelines for the practice of cardiothoracic surgery which is safe for both the patient and the healthcare team presents as a priority, which is the mainstay of this article.

This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.

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