Acute Mitral Regurgitation Research Articles

Transcatheter edge-to-edge repair in acute mitral regurgitation following acute myocardial infarction: Recent advances.

Acute mitral regurgitation (MR) is not a rare finding following acute myocardial infarction (AMI). It may develop due to papillary muscle rupture (primary MR) or due to rapid remodeling of the infarcted areas leading to geometric changes and leaflets tethering (secondary or functional MR). The clinical presentation can be catastrophic, with pulmonary edema and refractory cardiogenic shock. Acute MR is a potentially life-threatening complication and is linked to worse clinical outcomes. Until recently, medical treatment or mitral valve surgery were the only established treatment options for these patients. However, there is growing evidence for the benefits of safe and effective trans-catheter interventions in this condition, specifically transcatheter edge-to-edge repair (TEER). We aimed to review the current role of TEER in post-MI acute MR patients, focusing on different etiologies.

163: THINK INSIDE THE BOX: ACUTE MITRAL REGURGITATION MASQUERADING AS PEDIATRIC ARDS

Introduction: Acute mitral regurgitation (MR) due to papillary muscle rupture is a recognized complication of adult myocardial infarction but is rare in pediatrics. Presenting with dyspnea, acute pulmonary edema, and shock, acute MR can mimic acute respiratory distress syndrome (ARDS). Accurate and timely diagnosis is critical, as acute MR is a surgical emergency with high mortality risk. Description: A previously healthy 12-year-old male presented to the emergency department with one day of emesis, palpitations, and dyspnea. He was tachypneic, tachycardic, and hypoxemic and received supplemental oxygen and a 20 ml/kg fluid bolus. Chest radiograph showed bilateral infiltrates, point-of-care ultrasound (POCUS) was concerning for pneumonia, and antibiotics were given. POCUS also showed hyperdynamic left and normal right ventricular systolic function without pericardial effusion. He developed rapidly progressive hypoxic respiratory failure and was intubated. Intubation was notable for copious pink, frothy secretions. After PICU admission, he had progressive hemodynamic instability and rising lactate requiring escalation of vasopressors and inotropes. A complete echocardiogram showed mild MR and normal function. Due to rising mean airway pressure and worsening oxygenation index, he was cannulated to veno-venous extracorporeal membrane oxygenation. Repeat echocardiogram post-cannulation showed moderate to severe MR, prolapse of the anterior mitral leaflet, a prominent round papillary muscle, moderate left atrial dilation, mild-moderate left ventricular dilation, and hyperdynamic LV systolic function. Trans-esophageal echocardiogram confirmed diagnosis of acute MR due to papillary muscle rupture. He underwent mitral valve replacement with a St. Jude prosthetic mechanical valve. Pathologic evaluation of excised tissue showed lymphocytic myocarditis, endocardial inflammation, and patchy fibrosis. Rheumatologic evaluation is ongoing, and patient was discharged in good condition. Discussion: We report a rare presentation of lymphocytic myocarditis with papillary muscle rupture and acute MR. The presentation mimicked a rapid progression of pediatric ARDS, and highlights that a high index of suspicion is required to ensure timely diagnosis of this life-threatening process.

Unilateral Pulmonary Edema in Patients With Acute Mitral Regurgitation Caused by Chordal Rupture.

Background: Cardiogenic unilateral pulmonary edema (UPE) has been reported as an unusual condition and to occur in association with severe mitral regurgitation (MR). However, the prevalence of UPE in patients with severe MR remains unknown. Methods and Results: Among 143 consecutive patients with chordal rupture and significant MR, 38 patients with acute severe MR were studied. The prevalence of UPE was 50% (19 patients); all these patients had right-sided UPE. Eight (21%) patients had bilateral pulmonary edema (BPE). All 8 patients with BPE and 18 of 19 patients with UPE had chordal rupture of the posterior leaflet. All patients with UPE and BPE had severe MR with similar left atrial size. Chest radiographs taken ≤48 h from symptom onset diagnosed UPE in 15 of 19 (79%) patients and BPE in 3 of 8 (38%) patients (P=0.037). Chest radiographs taken >48 h from symptom onset diagnosed UPE in 4 (21%) patients and BPE in 5 (62%) patients (P=0.037). Conclusions: The prevalence of UPE was estimated as 50%; it was most frequently right sided and almost always associated with chordal rupture of the posterior leaflet. UPE is not rare, but common, particularly shortly after the development of acute severe MR caused by chordal rupture.

Intra-aortic Balloon Pump Securement.

Intra-aortic Balloon Pump Securement.

Abstract 12900: To Rescue or Not to Rescue? Multiple MitraClips for Ruptured Chordae on VA-ECMO

Background: Role of MitraClip as rescue therapy in patients with severe mitral regurgitation (MR) in the setting of ruptured chordae with profound cardiogenic shock in hypertrophic obstructive cardiomyopathy (HOCM) is not well known. Case: 60-year-old male presented with profound cardiogenic shock requiring ECMO with severe lactic acidosis. Past medical history included HOCM s/p septal ablation and ICD, mild MR, a-fib s/p watchman, and CKD stage 3.Transesophageal echocardiogram demonstrated a flail posterior mitral valve leaflet due to ruptured chordae tendineae with anteriorly directed jet of severe MR (figure 1A). VA-ECMO was initiated for profound hypotension. 3 MitraClips were required as rescue strategy as the patient was deemed too critical to undergo surgical repair. Post procedure, MR was mild with a mean MV gradient of 4 mmHg at the end of the procedure (figure 1B). 15 months post-hospitalization, patient reported dyspnea on exertion. Exercise stress echo revealed a mean MV resting gradient of 7 mmHg that increased to 16 mmHg at 50 W exercise (figure 1C). Invasive hemodynamics showed a mean gradient of 12 mmHg between LV end-diastolic pressure and pulmonary capillary wedge pressure (figure 1D) confirming severe mitral stenosis. The patient is currently being evaluated for surgical MV replacement. Discussion: Transcatheter edge-to-edge mitral valve repair (TMVr) has been studied extensively in patients with dilated cardiomyopathy, and chronic stable severe MR. There is limited data to show that TMVr can be used as salvage therapy in patients with acute torrential MR with underlying HOCM while being supported with ECMO. However, long-term sequelae needs meticulous follow up and prospective studies to establish short and long-term outcomes and safety. This case highlights potential role of TMVr in acute MR settings in the extreme case of profound cardiogenic shock requiring VA-ECMO leading to candidacy for mitral valve replacement in ambulatory setting.

Establishing Pediatric Cardiac Surgery Unit in Underprivileged Area. An Audit of First 100 Cases & Challenges Faced

Nevertheless, congenital anomalies predominantly cardiac are still leading cause of under five-year-old mortality. There is significant global improvement has been observed in declining of under 5-year mortality from 93 deaths per 1,000 births in 1990 to 39 in 2017 (58%).Objective: The aim of this audit was to present our experiences of first hundred cases of congenital heart defects surgeries along with the challenges faced during the establishment of new pediatric cardiac surgery center in underprivileged area. Methods: This was an audit of the first 100 cardiac surgeries performed for congenital heart defects at Gambat Institute of Medical Science from 15- 3- 2021 to1-10-2022. During the period challenges other then related with surgical interventions; more than an investment of money but political, cultural, and social faced. Results: The mean age was 9+/-6.5 years, with female predominance of 57. Sever pulmonary hypertension was present in 6 patients. The majority of our patients were from RACHS1 score category 1. Out of 100 patient open heart surgeries were 89(89%) and close heart were 11(11%). We have single mortality of patient underwent Tetralogy of Fallot correction developed massive stroke and expired at 5th postoperative day. Three patients were re explored for bleeding while one required emergency reopening in PICU for cardiac arrest. Post clamp removal arrhythmias were observed in 7(7%) patients. We received three patients in emergency from Pediatric cardiology post intervention including device embolization, device malposition and acute Mitral regurgitation post intervention. Conclusions: Providing Pediatric cardiac surgery services to the children of remote and socioeconomically deprived area is a greatly rewarding. It has many challenges other than providing direct patient care.

Early Postoperative Complications in Patients with Acute Myocardial Infarction During Emergency Coronary Bypassing

Despite the success results of interventional cardiology, the indications for coronary artery bypass grafting in acute myocardial infarction, according to the recommendations, are quite limited. In recent years, the optimization of perioperative management of patients, including myocardial protection, has helped to improve the effects of treatment by emergency surgical revascularization in patients with cardiogenic shock. Thus, it is important to learn the results of emergency surgical myocardial revascularization in patients with acute myocardial infarction (AMI), which were previously considered incurable or in cases where interventional cardiology is ineffective. Therefore, the aim of the study was to conduct a prospective analysis of the immediate clinical results of the early postoperative period to determine the factors of early mortality in emergency coronary artery bypass grafting. Research methods. The research is based on the prospective investigation of 129 patients who were hospitalized in Kyiv “Heart Center” through the period from 2011 to 2015. At 100,0% the ST-elevated myocardial infarction (STEMI) of them it was verified, at 29,0 patients non- ST-elevated myocardial infarction (NSTEMI) was set. In early postoperative period, we have analyzed such events like inotropic support duration, necessity of intra-aortic balloon pump, the episodes of the development kidney injury and respiratory failure, complete atrioventricular blockade, supraventricular tachyarrhythmia episodes, encephalopathy, rethoracotomy needs. Also early postoperative mortality endpoints were evaluated. Research results. It has been proven that in the presence of STEMI type of acute myocardial injury compared with NSTEMI type, there is a higher risk of acute left ventricular failure (p <0.05) followed by intra-aortic balloon pulsation (IABP)- procedure (p <0,05) and inotropic support (p <0,05) in the early postoperative period. In patients of the STEMI group, acute kidney injury was recorded more often with reliable indexes of absolute and relative risks (p <0,05). All cases of transient atrioventricular block after emergency coronary artery bypass grafting (CABG) were registered in patients with STEMI injury with significant changes of odds ratio (p <0.05). It was established that the main structure of respiratory complications was due to prolonged mechanical ventilation, but the difference in the relative risk and odds ratio between the STEMI and NSTEMI groups is insignificant (p> 0.05), however the likelihood of supraventricular arrhythmia and encephalopathy in the NSTEMI group was reliably higher (p <0.05). Estimates of the level of early postoperative mortality (12.4%) proved the probable relative risk (p <0.05) and the odds ratio (p <0.05) of mortality in the STEMI group, which was confirmed by the analysis of cumulative survival by Kaplan-Meyer method (Criterion log-rank 2,74; p = 0,006). Mortality in the STEMI group was associated with previously diagnosed acute heart failure (56,2%), the onset of cardiogenic shock (31,3%) and the development of acute mitral regurgitation (12.5%). Conclusions. STEMI type of acute myocardial damage installed reliably higher absolute and relative risk of acute left ventricle failure (p<0,05) with following intra-aortic balloon pump (p<0,05), inotropic support (p<0,05) and acute kidney injury with glomerular rate reduction (p<0,05) in the early postoperative period. The higher absolute and relative risks of encephalopathy, as well as the possibility of supraventricular arrhythmia presented at NSTEMI patients (p<0,05). All cases of transient atrioventricular blockade and early hospital mortality with reliable odds ratio, absolute and relative risks changes registered at STEMI patients (p<0,05). Prospects for further research are long-term prospective observation, analysis of long-term clinical results of coronary artery bypass grafting in patients with acute myocardial infarction, as well as assessment of risk factors for long-term mortality.

Trans-catheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation – a single centre experience

Abstract Introduction Recent series have demonstrated the benefit of trans-catheter edge-to-edge mitral valve repair (TEER) in acutely ill hospitalised patients with severe mitral regurgitation (MR) and intractable heart failure despite intensive intravenous therapy. We describe our cumulative experience with such patients at the Sheba Medical Centre over a 10 year period. Purpose The purpose of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure and severe MR that was deemed to play a major role in the patients' deterioration. Methods We included 30 hospitalised patients with intractable heart failure and MR ≥3+ (20 males; mean age 74.2±10.6 years; 10 had cardiogenic shock). MR was primary in 4, secondary in 24 and mixed in 2 patients. Acute results were assessed by echocardiography prior to discharge and safety was evaluated clinically, according to the occurrence of procedure-related adverse events. Mortality data were drawn from the national death registry. Results TEER devices were successfully implanted in 28 patients. Early (POD 1) procedure-failure was noted in one patient due to recurrence of flail. There was no peri-procedural mortality. Two patients were hemodynamically unstable during the procedure. One patient had peri-procedural access site bleeding necessitating blood transfusion. Following intervention, 16 patients required ICU care (mean stay 4.8±2.5 days), shock was recorded in 7 patients, 16 required hemodynamic support, and 8 required invasive ventilation. At 30 days 7 patients had died and an additional 4 died 1 to 6 months following intervention. However, mortality in the remaining patients was low with only 3 additional deaths up to 4 years after the procedure (80% of patients alive at 6 months). MR reduction was achieved in 24 patients (to ≤mild in 10 and to moderate in 11). At 12 months follow up MR severity was mild in 3 (37.5%) and moderate in 5 (62.5%) patients. Only 1 patient reported HF rehospitalisation during the year following the procedure. Conclusion TEER for hospitalised patients with severe MR and intractable heart failure is safe, associated with high early mortality, and good long-term outcome for patients alive 6 months after the procedure. More research is needed to better characterise patients likely to benefit from TEER in this clinical scenario. Funding Acknowledgement Type of funding sources: None.

Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review.

Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.

Urgent Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients with Refractory Cardiogenic Shock.

Introduction Patients suffering from cardiogenic shock (CS) and mitral regurgitation (MR) demonstrate worse prognosis, with higher mortality rates. We sought to evaluate the effectiveness of urgent valve intervention of the mitral valve, using transcatheter edge-to-edge repair (TEER) procedures in patients presenting with CS in a tertiary Intensive Coronary Care Unit (ICCU). Methods and Results Patients with unremitting CS and severe MR were selected for urgent TEER. Baseline clinical and echocardiographic characteristics were recorded, as well as procedural success (MR severity and hemodynamics), and 30-days and 6-month mortality. Urgent TEER was done in 13 patients, whose average age was 70 years; 12 (92%) of the patients were male. All 13 patients had suffered previous ischemic heart disease—12 (92%) with either acute severe MR or worsening of previously known MR by an acute ischemic event. Using the SCAI criteria, 8 patients (61%) were classified as ‘E’ (Extreme) category; 4 (31%) were classified as ‘C’. At 30 days, 12 out of the 13 patients survived (corresponding to an 8% mortality rate); all of those 12 patients remained alive at 6 months post-admission/procedure. Conclusions The use of TEER was associated with greater 30-day and 6-month survival rates, compared to the worldwide mortality rates of patients admitted with CS. This finding may change the previous paradigm that CS and MR are associated with the worst outcome, and we might be able to offer these patients a safe and effective therapeutic option.

Acute Ischaemic Mitral Valve Regurgitation.

Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the diagnosis and typical echocardiographic features, and evaluate current surgical and percutaneous treatment options for patients with acute IMR.

Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation due to Postinfarction Papillary Muscle Rupture.

Early case reports have suggested that transcatheter edge-to-edge repair (TEER) with the MitraClip for the treatment of acute mitral regurgitation (MR) due to post-infarction papillary muscle rupture (PMR) may be an alternative for patients at prohibitive surgical risk. However, data on consecutive patients treated for this condition is lacking. To define the procedural characteristics, medication use, hemodynamic parameters, and imaging data, we present 5 consecutive patients with acute MR from postinfarction PMR treated with TEER at Scripps Memorial Hospital La Jolla between June 2018 and November 2020. Successful reduction of MR and improved hemodynamics were achieved in all cases. Despite the procedural success, only 1 of the 5 patients survived until hospital discharge. TEER may be an effective treatment for acute MR due to postinfarction PMR to reduce MR and improve hemodynamics. Survival to discharge was infrequent, suggesting that TEER may be appropriate only in selected patients.

Management Challenge: An Atypical Variant of Takotsubo Presenting With Multiple Complications

An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.

Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation With Cardiogenic Shock Secondary to Mechanical Complication

IntroductionAcute MR due to mechanical mitral valve (MV) complications frequently results in cardiogenic shock and requires emergency surgical intervention. There was limited evidence for alternative treatment like MitraClip for patients at prohibitive surgical risk. We aimed to study the technical features and outcomes of emergency transcatheter edge-to-edge repair (TEER) using the MitraClip system for patients with cardiogenic shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV complication. Material and methodsWe performed institutional review and systemic literature review to identify all TEER for CS patients due to acute mitral regurgitation and mechanical MV complication. Clinical endpoints included device success rate assessed at the end of procedure, ability to wean off MCS, all-cause and cardiovascular mortality at 30-day. ResultsEight patients were identified from institutional review. Detail anatomical analysis found that patients with mechanical MV complications related to myocardial infarction had a lower transseptal height achieved during MitraClip (3.6 ± 0.1 cm vs 4.3 ± 0.3 cm, p = 0.03) than those not related. Pooled analysis for cases from institutional review (n = 8) and systemic literature review (n = 16) was performed. The device success rate was 68.8 %. Seventy-five percent (n = 18) cases required mechanical circulatory support (MCS), and 94.4 % were able to wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the all-cause mortality was 9.1 %. ConclusionsIn CS patients due to acute MR and mechanical MV complications, TEER with/without MCS was feasible with a reasonable device success rate.

Acute mitral valve regurgitation secondary to papillary muscle rupture due to infective endocarditis

BackgroundPapillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines.Case presentationThis case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge.ConclusionIn patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.

Atypical case of ischemic mitral regurgitation: pathogenetically based treatment

Introduction. The evolution of the study of mitral valve ischemic dysfunction influenced by fundamental and experimental research in recent years has led to a change of mitral leaflets role as a static component of the mitral valve in the pathogenesis of ischemic mitral regurgitation especially in the chronic myocardial ischemia.Objective. We report the clinical case of acute ischemic mitral regurgitation as a result of a chord rupture of the PML in a patient with unspecified duration of coronary artery disease without acute coronary syndrome and previous myocardial infarction including all stages of the diagnostic search and the results of surgical treatment.Conclusion. While performing reconstructive correction of the ischemic mitral regurgitation the possibility of reverse remodeling of the leaflets should be considered in case of removal the myocardial ischemia triggering factor. And therefore it is necessary to perform a full and adequate myocardial revascularization that combined with a full correction of all morphofunctional mitral valve changes guarantees the freedom from residual and recurrent mitral regurgitation.

Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications.

The outcomes of patients with acute myocardial infarctions (AMI) have significantly improved with advances in early reperfusion strategies; however, patients with massive infarcts or those who do not receive timely revascularization may develop mechanical complications of AMI. The most common mechanical complications are ventricular septal rupture (VSR), acute mitral regurgitation (MR) due to papillary muscle rupture, and free-wall rupture. Each complication is associated with a high risk of morbidity and mortality, and requires a multidisciplinary approach for prompt diagnosis and hemodynamic stabilization. Surgery is the mainstay of therapy but is associated with poor outcomes if performed too early during the treatment course for VSR or if performed too late with MR and free wall rupture. Optimal timing for surgery in combination with temporary circulatory support may be a feasible strategy for better results.

Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction.

Severe mitral regurgitation secondary to papillary muscle rupture is one of the mechanical complications after an acute myocardial infarction. Surgical strategies represent the cornerstone of treatment in this disease; in addition to surgical valve replacement, approaches involving surgical valve repair have been reported over time in different clinical scenarios to restore valve competency, improve cardiac function and reduce mechanical prosthesis-related risks. Moreover, in recent years, percutaneous trans-catheter procedures have emerged as an important alternative in high risk or inoperable patients.

Frequency of Acute Mitral Regurgitation in Post Percutaneous Transvenous Mitral Commissurotomy (PTMC) Patients with Severe Mitrall Stenosis (MS)

Objective: The goal of this study is to see how often Acute Mitral Regurgitation is in patients with severe mitral stenosis who have undergone a percutaneous transvenous mitral commissurotomy (PTMC). Study Design: Cross-sectional study Pace and Duration: The study was carried out at cardiology department of Lady Reading Hospital MTI, Peshawar and PIMS hospital, Islamabad for the duration of six months from 16th August 2021 to 15th February 2021. Methods: A total of 85 patients of both genders that underwent percutaneous transvenous mitral commissurotomy (PTMC) were included in this study. A detailed demographic profile of recruited patients including age, gender and body mass index (BMI) was compiled after obtaining informed written permission from each patient. A technician with over 10 years of experience examined pre- and post-procedure mitral regurgitation using a transthoracic echocardiography (TTE). Frequency of complication was also recorded. SPSS 21.0 was used to analyze all data. Results: Among 85 patients, there were 65 (76.5%) females and 20 (23.5%) males. Mean age of the patients was 39.8 ±9.54 years and mean BMI 24.6±11.42 kg/m2. Previous commissurotomy was found in 9 (10.5%) cases. Pre-operative mean balloon size 26.5±1.88 and mitral valve area was 1.1±0.32. Frequency of severe mitral regurgitation found in 15 (17.6%) cases. 75 (88.2%) patients had no previous history of commissurotomy and the majority were females. Among 9 cases of severe MR, 4 (44.4%) had no previous history of commissurotomy. Conclusion: According to our study, few PTMC patients had significant mitral regurgitation. Procedure is safe and effective. A multiethnic, multicenter, multicity research is proposed in Pakistan to evaluate genetic, environmental, and hospital-related variables associated with post-procedural problems in patients with severe mitral regurgitation who received PTMC. Keywords: PTMC, Mitral Regurgitation, Post Percutaneous Transvenous Mitral Commissurotomy, Local Site complications, MR, Cardiac Tamponade

Mechanical circulatory support in cardiogenic shock and post-myocardial infarction mechanical complications.

Despite advanced therapies, the mortality of patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) remains around 50%. Mechanical complications of MI are rare nowadays but associated with high mortality in patients who present with CS. Different treatment strategies and mechanical circulatory support (MCS) devices have been increasingly used to improve the grim prognosis of refractory CS. This article discusses current evidence regarding the use of MCS in MI complicated by CS, ventricular septal rupture, free wall rupture and acute mitral regurgitation. Device selection should be tailored according to the cause and severity of CS. Early MCS initiation and multidisciplinary team cooperation is mandatory for good results. MCS associated bleeding remains a major complication and an obstacle to better outcomes. Ongoing prospective randomized trials will improve current knowledge regarding MCS indications, timing, and patient selection in the coming years.