The recent advances in the management of postinfarct ventricular septal rupture have helped to decrease the operative mortality rate to 10% in one series. The addition of coronary artery bypass grafting seems to improve long-term survival despite having little effect on hospital mortality. Recent technical improvements have helped to decrease postoperative bleeding and may preserve ventricular function. Patients undergoing shunt repair today tend to be older and more likely to have received thrombolytic agents, which may complicate the repair. Survival and quality of life are excellent even in patients older than 70 years after successful repair.