Optimization of cardiac surgery outcomes by use of modern imaging modalities

This thesis investigates the integration of advanced cardiovascular magnetic resonance (CMR) imaging and extended reality (XR) technologies to enhance diagnosis, surgical planning, and patient outcomes in cardiac surgery. It examines how these emerging tools refine clinical stratification, improve patient engagement, and support precision-based surgical care.
The first part of this thesis focuses on CMR in the evaluation and management of mitral valve regurgitation (MR), a condition often challenging to assess using echocardiography alone. CMR enables accurate quantification of left ventricular (LV) and atrial (LA) volumes, tissue fibrosis, and MR severity, offering improved risk stratification. Data from the Dutch AMR registry reveal comparable outcomes between early and delayed mitral valve repair (MVR) in asymptomatic patients, suggesting that CMR-derived markers such as LV or LA fibrosis could guide more individualized timing of intervention. Additionally, 4D-flow CMR demonstrates the ability to distinguish postoperative hemodynamic variations in hypertrophic cardiomyopathy, indicating potential value for tailoring surgical strategies.
The second part of the thesis explores XR applications across the surgical continuum; from preoperative planning to postoperative recovery. Virtual reality (VR) proved effective in reducing postoperative pain and enhancing patient satisfaction through improved visualization of procedures, although its suitability varies among patients. A custom XR tool for coronary artery bypass grafting demonstrated feasibility for 3D visualization and intraoperative navigation.
Overall, this thesis advocates for evidence-based integration of advanced CMR and XR technologies in cardiac surgery to enhance diagnostic precision, optimize timing, and strengthen patient-centered care.