[The surgical treatment of acute myocardial infarct in the 90s]
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Updated: Oct 25, 2026
Semi-Minimal Invasive Method to Induce Myocardial Infarction in Rats and the Assessment of Cardiac Function by an Isolated Working Heart System
Published on: June 11, 2020
1Serviço de Cirurgia Cardiotorácica, Hospitais da Universidade, Coimbra.
Insights
Timely revascularization surgery for acute myocardial infarction offers excellent long-term results and low mortality. However, logistical challenges limit its use, making it reserved for specific patient groups.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Acute Myocardial Infarction Treatment
Context:
- Current acute myocardial infarction treatment focuses on revascularization within six hours of coronary occlusion.
- Despite low mortality (around 2%) and excellent long-term outcomes, timely surgical intervention is underutilized due to infrastructure, cost, and timing limitations.
- Surgery remains the definitive treatment for mechanical complications of myocardial infarction, including ventricular septal rupture and mitral regurgitation.
Purpose:
- To review the current status and outcomes of surgical interventions for acute myocardial infarction and its complications.
- To highlight the benefits of early surgical treatment versus later interventions.
- To discuss advancements in myocardial preservation techniques improving surgical results.
Summary:
- Revascularization within six hours of acute myocardial infarction onset yields good results but faces limited application.
- Delayed surgery (after 72 hours) shows good outcomes in non-emergency settings.
- Advanced myocardial preservation techniques enhance surgical outcomes for infarction complications like ventricular septal rupture and mitral regurgitation.
Impact:
- Improved understanding of the indications and outcomes for surgical management of acute myocardial infarction.
- Identifies barriers to timely surgical intervention and suggests areas for infrastructure and logistical improvement.
- Emphasizes the critical role of surgical repair in managing mechanical complications and the positive impact of myocardial preservation strategies.
Abstract:
At present, the treatment for acute myocardial infarction is revascularization during the critical initial period of six hours after the beginning of coronary occlusion. Despite the fact that surgery performed within this time period presents a hospital of mortality around 2%, and with excellent results in the long term, it is seldom used due to logistic limitations and capabilities of hospital infrastructures, high costs and the possibility of the surgical team initiating surgery inside the useful time period. Surgery is thus limited to the patients with suitable anatomy, who are not candidates or had failure of thrombolytic/angioplasty therapy and are in the six-hour period after initiation of symptoms. Surgery performed at a later stage has good results if performed in a non emergency situation, specially after the first 72 hours. Surgery continues to be the only treatment for the mechanical complications of infarction, and good results have recently been shown in ventricular septal ruptures, with hospital mortality of 14%, due to the use of an endoventricular patch in patients operated early, before the consequences of low cardiac output develop at systemic level. In the surgical treatment of mitral regurgitation, the tendency has been to use repair techniques whenever possible, but still with hospital mortality up to 15%. The recent advances of the techniques and tactics of myocardial preservation during surgery have made a very significant contribution to the better results we see today.
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