Transcatheter Management of Acute Mechanical Complications Post-Myocardial Infarction

Mechanical complications following acute myocardial infarction (MI) represent some of the most challenging conditions in contemporary cardiology, often leading to rapid clinical deterioration and high mortality despite advances in reperfusion therapy. These complications span a spectrum of presentations, from early-phase structural disruptions such as ventricular septal rupture, papillary muscle rupture with acute mitral regurgitation (MR), and left ventricular free wall rupture (LVFWR), to later-stage manifestations, including true ventricular aneurysms and pseudoaneurysms. While surgical intervention has traditionally been considered the standard of care, surgical intervention is often associated with prohibitive risk in hemodynamically unstable or frail patients. In this context, transcatheter approaches have gained traction as viable, less invasive alternatives, offering the potential for hemodynamic stabilization, symptom relief, and improved short-term outcomes in selected patients. Nonetheless, data from observational studies and registry-based analyses remain limited, underscoring the need for further research. This review synthesizes the current evidence base and clinical experience related to transcatheter management of mechanical complications after MI, emphasizing patient selection, procedural strategies, device selection, and reported outcomes.