The surgeon's role in the treatment of acute myocardial infarcts is limited to selected cases in which emergency revascularization can be performed with reasonable expectation for salvage of an ischemic, however, still viable myocardium. This goal can be achieved under optimal logistic conditions. At present the result of emergency revascularization can not be predicted with certainty due to the lack of diagnostic methods which would allow for instantaneous differentiation between ischemic and necrotic myocardium. Surgical techniques are established for infarct sequelae such as ventricular rupture, papillary muscle necrosis, and ventricular septal defect, however, the outcome of emergency operations in these instances is primarily determined by the duration and intensity of preoperative circulatory failure. Cardiac transplantation with or without temporary mechanical support or replacement appears to be the future treatment of choice in acute irreversible congestive heart failure and global ventricular impairment following myocardial infarction
