Management and outcomes of post-myocardial infarction left ventricular pseudoaneurysm: A case-level systematic review

Left ventricular pseudoaneurysm (LVPA) is a rare mechanical complication of acute myocardial infarction (MI) associated with significant mortality. Given the paucity of available data in the literature, we sought to pool existing evidence to better understand the current management strategies and outcomes. Electronic search was performed in February 2025 to identify all studies reporting management of post-MI LVPA. A total of 158 reports, with a total of 159 patients were included. Patient-level data were extracted for analysis.

A total of 159 patients were included in the analysis. The median age was 65 years [Interquartile range (IQR), 57–75], and 70% (106/159) of patients were male. The most frequent site of MI was inferior wall (31.4%, 49/156) and the most common method of MI management was thrombolysis (49%, 64/131). The median time from MI to presentation signs/symptoms of LVPA was 21 days [IQR, 0–152]. The most common LVPA location was the anterior/apical wall (27.7%, 44/159). Sixty-six percent of patients (105/159) underwent surgical repair, while 22% of patients (35/159) were managed medically and 5.7% (9/159) of patients underwent transcatheter repair. In-hospital/30-day mortality was 10% (16/159), with operative mortality after surgical repair of 4.8% (5/105). Mortality from reoperative surgery was 18.8% (3/16) as opposed to 2.2% (2/89) in patients without redo sternotomy (p = 0.004). Periprocedural mortality among patients treated with transcatheter intervention occurred in a single case (11.1%), involving a patient with prior coronary artery bypass grafting. At a median follow-up of 6 months [IQR, 1–12], overall survival was 86.1% (137/159).

Surgery remains the standard therapy of LVPA, with acceptable operative risk, however, re-operative sternotomy carries higher surgical risk. In carefully selected patients, percutaneous repair may serve as a viable alternative to surgery.