Interdiscip Cardiovasc Thorac Surg. 2025 Nov 6;40(11):ivaf236. doi: 10.1093/icvts/ivaf236.

ABSTRACT

OBJECTIVES: Although rare, aorto-oesophageal fistula remains one of the most critical diseases in cardiovascular surgery. The lack of prospective studies or large case series leads to an absence of evidence-based therapeutic concepts.

METHODS: We conducted a retrospective analysis of patients treated for aorto-oesophageal fistula between 2014 and 2023. Primary endpoints of analysis were 30-day mortality and median survival; subgroup analysis was performed for aetiology as well as treatment strategy. Additionally, a systematic search was conducted for all studies researching treatment of the disease, including ≥5 patients and published within the last 10 years.

RESULTS: In the collective of 10 patients, 4 manifested as primary fistula, while in 6 patients the fistula occurred secondary to previous thoracic endovascular aortic repair. Median duration to manifestation post-TEVAR was 20.1 months (34.1). Initial treatment consisted of TEVAR or TEVAR-relining in 7 cases, followed by bovine open aortic replacement (n = 1) or partial bovine patch repair (n = 2) when viable. Treatment of the oesophagus consisted of primary suture (n = 1) or oesophagectomy (n = 5) with gastric pull-up or colon interposition. Overall 30-day mortality was 40%, and overall median survival was 7.5 months (12.8). Patients receiving surgical treatment of the oesophagus exhibited longer survival than patients who did not (12.8 months [4.7] vs 0.35 months [0.4]). Across the reviewed literature, the strongest effect on survival originates from surgical treatment of the oesophagus. Specific surgical strategies as well as patient characteristics vary widely.

CONCLUSIONS: We found TEVAR effective in stabilizing the initial haemorrhage. Short-interval oesophagectomy seems to improve survival and should be considered in most patients. Open aortic replacement with bovine pericardium is a viable option. Interventional treatment options alone do not appear to be sufficient.

PMID:41105160 | PMC:PMC12622961 | DOI:10.1093/icvts/ivaf236