2025 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Surgical management of acute myocardial infarction and associated complications

Abstract

Background: Complications of acute myocardial infarction (AMI) can result in significant morbidity and mortality. This document reports the findings and recommendations of a multidisciplinary group of experts on the management of patients with complications of AMI, with particular focus on the use of mechanical circulatory support in this context.

Methods: Through the American Association of Thoracic Surgery Clinical Practice Standards Committee, a committee of multidisciplinary experts, including both cardiologists and cardiothoracic surgeons, was established. A list of topics was developed. Committee members were divided into subgroups that developed relevant questions. A systematic literature review was then performed, and the results were synthesized into clinical recommendations. Expert consensus was then established using the Delphi process.

Results: Based on the results of the systematic literature review, as well as the clinical expertise of the committee, clinical recommendations were developed. Each of these recommendations, the strength of each recommendation, and the level or quality of evidence on which the recommendation was based are presented here. Topics addressed include general considerations, revascularization strategies, cardiogenic shock, papillary muscle rupture, postinfarction ventricular septal defect, free wall rupture, arrhythmias, and the use of durable therapies in this context.

Conclusions: AMI may result in cardiogenic shock, malignant arrhythmias, or mechanical complications, each of which is associated with high mortality. Prompt management of these complications, including consideration for mechanical circulatory support, is warranted.

Keywords: acute myocardial infarction; arrhythmia; cardiogenic shock; free wall rupture; mechanical circulatory support; papillary muscle rupture; postinfarction ventricular septal defect.