[Surgical treatment of mechanical complications of myocardial infarction after 65 years of age].

Age does not seem to influence either the operative mortality or the incidence of mechanical complications of myocardial infarction, although for some authors rupture of the free wall is more frequent in the elderly. On the other hand, post-operative morbidity is higher in the elderly because the acute haemodynamic disturbances involved often aggravate renal, pulmonary and cerebral degenerative lesions. This paper studies the present data on surgical treatment. Two-dimensional echocardiography has improved diagnosis of free wall rupture as well as of the mechanism of mitral insufficiency. The indications for, and duration of, circulatory assistance using an intra-aortic balloon are now well established in mitral insufficiency and interventricular communication. The introduction of cardiac paralysis, the use of low-profile bioprostheses and coronary revascularisation have improved the surgical results of mitral valve replacement. The techniques of closing interventricular communications together with the treatment of aneurysms are now well established. Where aneurysms are concerned, the methods vary depending on whether it is a false or true aneurysm; in the latter case we discuss aneurysmectomy and surgery for arrhythmia. The only contra-indications to this kind of surgery remain senility and the existence of far advanced associated pathology (whether renal, pulmonary, cerebral or neoplastic).