TY - JOUR
T1 - Surgical Treatment of Atrioesophageal Fistula
T2 - A Systematic Review
AU - Amirkhosravi, Farshad
AU - Azimuddin, Ahad
AU - Nguyen, Duc T.
AU - Chihara, Ray
AU - Chan, Edward Y.
AU - Graviss, Edward A.
AU - Reul, Ross M.
AU - Kim, Min P.
N1 - Funding Information:
The authors wish to thank Rachael Whitehead for the illustration. The authors have no funding sources to disclose. Min P. Kim reports a relationship with Intuitive Surgical Inc, Medtronic Inc, and Olympus Corporation of the Americas that includes consulting or advisory and speaking and lecture fees, and a relationship with AstraZeneca Pharmaceuticals LP that includes consulting or advisory. Edward Chan reports a relationship with Intuitive Surgical Inc and Olympus Corporation of the Americas that includes consulting or advisory and speaking and lecture fees. The other authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2023 The Society of Thoracic Surgeons
PY - 2023/8
Y1 - 2023/8
N2 - BACKGROUND: Atrioesophageal fistula is a rare and morbid complication of ablation therapy for atrial fibrillation. Surgery provides increased survival; however, which surgical approach provides the best outcome is unclear.METHODS: We performed a retrospective analysis of cases in the literature and at our institution. We characterized patients by presenting symptoms, diagnostic method, surgical therapy with different approaches, and survival.RESULTS: In total, 219 patients were found, with 216 patients identified from 122 papers in the literature and 3 patients from our institutional database (2000-2022). The most common presenting symptoms included fever/chill (71.8%) and neurologic deficiency (62.9%). The overall survival for this cohort was 47%. Patients who had an operation had significantly improved survival compared with those who did not have an operation (71.9.3% vs 11%, P < .001). Patients who survived after surgical intervention typically underwent right thoracotomy (45.1%), patch repair of the left atrium (61.1%), and primary repair of the esophagus (68.3%) on cardiopulmonary bypass (84.8%) with a flap between the 2 organs (84.6%). Patients who had cardiopulmonary bypass had increased survival (39 of 45 [86.7%]) compared with those who did not have cardiopulmonary bypass (7 of 17 [41.2%], P < .001).CONCLUSIONS: Patients with atrioesophageal fistula should undergo surgical intervention. A patch repair of the left atrium and primary repair of the esophagus with a flap between the organs during cardiopulmonary bypass is the most common successful repair. Cardiopulmonary bypass may allow better débridement and repair of the left atrium, which may provide a survival advantage in the treatment of this rare disease.
AB - BACKGROUND: Atrioesophageal fistula is a rare and morbid complication of ablation therapy for atrial fibrillation. Surgery provides increased survival; however, which surgical approach provides the best outcome is unclear.METHODS: We performed a retrospective analysis of cases in the literature and at our institution. We characterized patients by presenting symptoms, diagnostic method, surgical therapy with different approaches, and survival.RESULTS: In total, 219 patients were found, with 216 patients identified from 122 papers in the literature and 3 patients from our institutional database (2000-2022). The most common presenting symptoms included fever/chill (71.8%) and neurologic deficiency (62.9%). The overall survival for this cohort was 47%. Patients who had an operation had significantly improved survival compared with those who did not have an operation (71.9.3% vs 11%, P < .001). Patients who survived after surgical intervention typically underwent right thoracotomy (45.1%), patch repair of the left atrium (61.1%), and primary repair of the esophagus (68.3%) on cardiopulmonary bypass (84.8%) with a flap between the 2 organs (84.6%). Patients who had cardiopulmonary bypass had increased survival (39 of 45 [86.7%]) compared with those who did not have cardiopulmonary bypass (7 of 17 [41.2%], P < .001).CONCLUSIONS: Patients with atrioesophageal fistula should undergo surgical intervention. A patch repair of the left atrium and primary repair of the esophagus with a flap between the organs during cardiopulmonary bypass is the most common successful repair. Cardiopulmonary bypass may allow better débridement and repair of the left atrium, which may provide a survival advantage in the treatment of this rare disease.
KW - Humans
KW - Esophageal Fistula/diagnosis
KW - Retrospective Studies
KW - Heart Diseases/etiology
KW - Catheter Ablation/adverse effects
KW - Atrial Fibrillation/surgery
KW - Heart Atria/surgery
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U2 - 10.1016/j.athoracsur.2023.04.016
DO - 10.1016/j.athoracsur.2023.04.016
M3 - Review article
C2 - 37084936
AN - SCOPUS:85159095160
SN - 0003-4975
VL - 116
SP - 421
EP - 428
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -