Dr. Gardner continues to make excellent and insightful comments.  He discusses the topic which is unfortunately the foundation for the ‘battle’ between interventional cardiologists and cardiac surgeons.  CABG vs. PCI continues to cause significant disagreement between these two specialties.  While I believe we all have our patients needs at ‘heart’ I think this issue has become more of a political and financial battle.  As Dr. Gardner points out it is very similar to what we have seen in Congress with either side refusing to even consider the other side’s point of view.  The reality is that there are compelling arguments for both sides and at the end of the day this needs to be a patient specific decision.  This is of course best done by a multidisciplinary heart team that should include a non-interventional (ideally the patients own) cardiologist.  In all patients we need to consider medical, interventional, surgical or hybrid (my favorite) options to treat their coronary disease.  It is important when these groups meet that the foundation is that of ideal treatment of the patient.  While there will be contentious topics this should not be viewed as a battle ground.  We have seen this approach applied successfully in the groups with valve clinics deciding TAVR vs AVR and this should serve as the model.  Unfortunately we have also seen the PCI v. CABG issue arise in terms of transapical (or transaortic) vs transfemoral TAVR.  I hope that going forward in all areas focused on treating cardiovascular disease that we avoid the ingrained approach of ‘us vs. them’ and create teams focused exclusively on the patient.  I personally believe this will best be done by aligning incentives among the practitioners so we are all truly one team.