Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes

Abstract

Background: Mechanical complications following acute myocardial infarction (AMI), though rare, are associated with significant morbidity and mortality. Surgical management remains a mainstay of therapy for these complications. The purpose of this review is to evaluate long-term outcomes data of surgical management for postinfarction free wall rupture, ventricular septal defect, papillary muscle rupture, and pseudoaneurysm.Methods: An electronic literature search was performed to identify original studies reporting long-term outcomes data of surgical management of one of the four mechanical complications following AMI. Studies were considered to have long-term outcomes if they at minimum included survival or mortality data up to one year.Results: A total of 285 studies were identified from the literature search. Of these, 29 studies with longterm survival data on surgically managed mechanical complications of AMI are included in the review. The majority of these are retrospective cohort studies or single-center case series. Five studies are included on free wall rupture, 18 on ventricular septal defect, 4 on papillary muscle rupture, and 2 on pseudoaneurysm.Detailed results are tabulated according to complication.Conclusions: Long-term surgical outcomes of postinfarction mechanical complications remain understudied. Outcomes for ventricular septal defect repair are better represented in the literature than are outcomes for other mechanical complications, though available studies are still limited by small sample sizes and retrospective design. Further research is warranted, particularly for outcomes of acute pseudoaneurysm repair.

Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

“…Similarly, transcatheter closure of VSR has been demonstrated to be feasible and effective in the deferred period of the rupture. The high mortality of VSR patients undergoing percutaneous or surgical repair in the acute phase may be related to the infarcted myocardium, which is weak and fragile, and the unstable hemodynamic status in the acute phase after AMI [ 8 ]. Female sex and Killip Class III-IV at admission are associated with an increased risk of death in the acute phase of VSR after infarction.…”

Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction

“…(4) The follow-up period was relatively short. Meanwhile, follow-up mainly relied on outpatient services, and some therapeutic information could have been missed, which might affect the incidence of CR ( 39 ). Therefore, high qualified studies are needed to confirm these findings.…”

Complicaciones mecánicas post infarto agudo de miocardio

“…Por otro lado, algunos estudios han expuesto la relación de factores de riesgo y el sexo, evidenciándose que el sexo femenina suele tener una aparición de síndrome coronario, de forma más tardía con la presencia de sintomatología atípica, llevándolo así a una mayor predisposición de nuevas intervenciones, aumento de la mortalidad y la aparición de complicaciones (Chávez et al, 2020). Es por ello que en todos los pacientes con IAM de gran magnitud, de tardía aparición o en los cuales el proceso de revascularización ha sido demorado, la intervención percutánea es una de las terapéuticas estándar; no obstante, en cuanto a las complicaciones mecánicas y su repercusión en la hemodinamia normal de los pacientes, ha hecho que la letalidad de las mismas se han conservado con el mismo impacto (Damluji et al, 2021;Yousef et al, 2022).…”

“…Para el abordaje de dichos pacientes es necesario establecer un enfoque inicial como es la estabilización de la placa, y una disminución de la poscarga, además siempre es imprescindible una terapia de revascularización quirúrgica y utilización de vasodilatadores e inotrópicos; sin embargo por el riesgo de inestabilidad hemodinámica, deber ser primordial el reparo quirúrgico, ya sea con un bypass aortocoronario, un balón contrapulsación o un cierre percutáneo (Barik, 2016;Morales-Camachoa et al, 2017;Yousef et al, 2022).…”

“…Sin importar el método con el que se lleve a cabo la reducción de la poscarga, no dejara de ser una medida provisional hasta que se pueda cerrar la anomalía completamente. Ya que si no se lleva a cabo el proceso por completo, la tasa de mortalidad se incrementa al 80% en 30 días, mientras que a largo plazo en la misma se considera un aumento al 94% aun con tratamiento médico (Yousef et al, 2022).…”