To identify risk factors for hospital mortality after postinfarction left ventricular aneurysmectomy (PILVA), 83 consecutive cases of PILVA were studied in a retrospective analysis. Hospital mortality was 14.4%. Most of the factors correlated with hospital mortality were associated with poor overall left ventricular (LV) function: preoperative digoxin (P = 0.001), diuretics (P = 0.03), intravenous (iv) inotropics (P = 0.002), interstitial oedema (P = 0.03) on chest X-ray, higher LV end-diastolic pressure (P = 0.02), congestive heart failure (CHF) (P = 0.003) especially as an indication for surgery (P = 0.001) and postoperative low output (P less than 0.001), intra-aortic balloon pump (IABP) (P less than 0.001) and renal failure (P less than 0.001). In addition, higher age at infarction (P = 0.002) and at PILVA (P = 0.008) were correlated with hospital mortality, as well as preoperative antiarrhythmics (P = 0.03) and incomplete coronary artery bypass grafting (P = 0.01). Multivariate analysis of preoperative factors showed digoxin, antiarrhythmics, CHF as an indication for surgery, iv inotropics and iv nitrates, in this order, to be the most discriminating risk factors, predicting hospital mortality with 89% specificity and 75% sensitivity. Multivariate analysis of all investigated factors showed postoperative renal failure and IABP, age at infarction, preoperative iv nitrates and antiarrhythmics, in this order, as the most discriminating risk factors, predicting hospital mortality after PILVA with 97% specificity and 83% sensitivity.