[The surgical treatment of acute myocardial infarct in the 90s].

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.