Clinical Characteristics and Early Surgical Outcomes of Aortoesophageal Fistula

Toru Iwahashi; Hiroyuki Yamamoto; Noboru Motomura; Hideyuki Shimizu; Yutaka Okita; Yoshiki Sawa; Hitoshi Ogino

doi:10.1016/j.athoracsur.2024.09.035

Clinical Characteristics and Early Surgical Outcomes of Aortoesophageal Fistula

Ann Thorac Surg. 2024 Oct 9:S0003-4975(24)00843-9. doi: 10.1016/j.athoracsur.2024.09.035. Online ahead of print.

Authors

Toru Iwahashi¹, Hiroyuki Yamamoto², Noboru Motomura³, Hideyuki Shimizu⁴, Yutaka Okita⁵, Yoshiki Sawa⁶, Hitoshi Ogino⁷

Affiliations

¹ Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
² Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Chiba, Japan.
⁴ Department of Cardiovascular Surgery, Keio University, Tokyo, Japan.
⁵ Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan.
⁶ Department of Cardiovascular Surgery, Osaka University Medical School, Osaka Japan.
⁷ Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. Electronic address: hogino@tokyo-med.ac.jp.

PMID: 39389285
DOI: 10.1016/j.athoracsur.2024.09.035

Abstract

Background: The incidence and prognosis of aortoesophageal fistula (AEF) has not been clarified. The clinical characteristics and surgical outcomes of AEF were investigated.

Methods: The clinical data of patients who underwent surgical treatment of AEF from January 2020 to December 2021 that were registered in the Japan Cardiovascular Surgery Database (JCVSD) were analyzed.

Results: During the period, 123 patients (aged 71.0 years [interquartile range, 61.0-78.0 years]; 76.4% men) underwent surgical treatment of AEF. The prevalence of secondary AEF was 61%. Secondary AEF after aortic grafting was the most frequent (n = 40 [32.5%]), followed by AEF after thoracic endovascular aortic repair (TEVAR; n = 30 [24.4%]). Operative mortality occurred in 23 patients (18.7%). TEVAR for AEF (P = .019). Univariable logistic regression analyses showed postoperative bleeding (P = .047), stroke (P = .004), renal failure (P < .001), newly required hemodialysis (P = .023), pneumonia (P = .003), multisystem failure (P < .001), and dyslipidemia (P = .02) were associated with risk factors of operative mortality after surgical treatment of AEF.

Conclusions: This nationwide study on the surgical treatment of AEF demonstrated a higher incidence of secondary AEF than primary AEF. Open surgical repair and TEVAR for AEF were both associated with high operative mortality. TEVAR and dyslipidemia were risk factors for operative mortality. Precautions and further improved treatment strategies for AEF are still required.