Functional mitral regurgitation (MR) – also referred to as secondary MR – is a disease condition which results from a combination of annular dilatation, papillary muscle displacement with increased... Show moreFunctional mitral regurgitation (MR) – also referred to as secondary MR – is a disease condition which results from a combination of annular dilatation, papillary muscle displacement with increased systolic leaflet tethering, and reduced closing forces, due to regional or global left ventricular (LV) remodelling.Functional MR is a common phenomenon and can be classified as either ischaemic or non-ischaemic, based on aetiology of LV remodelling. Regardless of aetiology, functional MR carries a poor prognosis.The primary step in the treatment of patients with functional MR consists of optimal medical and device therapy. In patients with persistence of MR despite optimal medical and device therapy, surgical treatment options can be considered. Over the past decades, many surgical treatment options have been developed, of which mitral valve repair by implantation of a restrictive mitral annuloplasty (RMA) ring forms the mainstay.In this thesis an integrated medico-surgical approach for patients with functional MR was examined, consisting of optimal medical and device therapy combined with RMA, and additional surgical interventions when indicated. The indication for each surgical intervention was determined after careful balancing of treatment options by the multidisciplinary Heart Team – consisting of heart failure specialists, interventional cardiologists, arrhythmia cardiologists and cardiac surgeons. Focus of this thesis was to determine (long-term) clinical and echocardiographic outcomes after this approach and to identify which patients are (un)likely to benefit from it. Show less
In this thesis the surgical options for treatment of functional mitral regurgitation (MR) are described. In functional MR, the mitral valve has a normal anatomy, which distinguishes this type of... Show moreIn this thesis the surgical options for treatment of functional mitral regurgitation (MR) are described. In functional MR, the mitral valve has a normal anatomy, which distinguishes this type of insufficiency from organic MR. Regurgitation in functional MR is related to an abnormal geometry of the left ventricle, which can be the result of an infarction or ischaemia, or may be caused by another__intrinsic__disease of the myocardium. Based on aetiology, we can distinguish ischaemic and non-ischaemic functional MR. Patients with functional MR often present with signs and symptoms of heart failure. Current guidelines do not offer clear treatment algorithms for these patients, and an intervention on the mitral valve is often discouraged, mainly because of contradictory results from studies on surgical interventions on the valve. In this thesis, the role of surgery in the multidisciplinary treatment of patients with functional MR, typically associated with heart failure, is evaluated with regard to clinical and echocardiographic outcomes. The ultimate goal is to establish an individualised medico-surgical approach to this pathology. As such, this thesis results from close collaboration between the departments of Cardiothoracic Surgery and Cardiology of the Leiden University Medical Center. Show less
