Surgical and transcatheter treatments of mechanical complications of acute myocardial infarction

Introduction

Major advances in reperfusion therapies after acute myocardial infarction (AMI) have resulted in dramatic reductions in the rate of mechanical complications including ventricular septal defect (VSD), free wall rupture (FWR) and papillary muscle rupture (PMR). However, the drastic decline in their incidence has not been accompanied by a similar decrease in their risk of major morbidity and mortality, which have remained mostly unchanged for the past two decades in the contemporary era of primary percutaneous coronary intervention (PCI). A multidisciplinary heart team approach facilitates timely recognition, diagnosis and management of complex haemodynamics and shared decision making regarding pursuit of a definitive intervention or palliation. There are few high-quality studies to guide management of these complex patients, leading to significant variability in care patterns that depend on local expertise and resource availability. The purpose of this review is to describe the clinical presentation of these patients, summarise the existing evidence to guide management, and highlight outcomes with a focus on evolving surgical and percutaneous treatment options.