Postmyocardial infarction ventricular septal rupture: optimizing surgical timing and repair

A diagnosis of a post-MI ventricular septal rupture carries a poor prognosis. Without surgical intervention, the likelihood of 1-year survival is very low. Percutaneous treatment options have limited success, and the gold standard remains surgical intervention. Surgical timing is often dictated by patients being hemodynamically unstable and requiring emergent surgery. When a patient can have delayed intervention, there is a trend towards better outcomes. Optimized hemodynamics, metabolic parameters, and initial medical management are associated with improved outcomes. Mechanical circulatory support is of benefit in sicker patients if it can assist with preoperative optimization.