Clinical Characteristics and Early Surgical Outcomes of Aortoesophageal Fistula.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-10-09 DOI:10.1016/j.athoracsur.2024.09.035

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

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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.

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主动脉食管瘘的临床特征和早期手术效果。

背景：主动脉食管瘘（AEF）的发病率和预后尚未明确。研究人员对 AEF 的临床特征和手术效果进行了调查：分析了日本心血管外科数据库（JCVSD）中登记的 2020 年 1 月至 2021 年 12 月期间接受 AEF 手术治疗的患者的临床数据：在此期间，共有 123 名患者（71.0 [IQR: 61.0-78.0] 岁；76.4% 为男性）接受了 AEF 手术治疗。继发性 AEF 的发病率为 61%。主动脉移植术后继发性 AEF 的发生率最高（n = 40；32.5%），其次是胸腔内血管主动脉修复术（TEVAR）后的 AEF（n = 30；24.4%）。23名患者（18.7%）出现手术死亡率。TEVAR治疗AEF（p = 0.019）、术后出血（p = 0.047）、中风（p = 0.004）、肾衰竭（p < 0.001）、新需血液透析（p = 0.023）、肺炎（p = 0.003）、多系统衰竭（p < 0.001）和血脂异常（p = 0.02）在单变量逻辑回归分析中与 AEF 手术治疗后的手术死亡率风险因素相关：这项首次在全国范围内开展的AEF手术治疗研究表明，继发性AEF的发病率高于原发性AEF。AEF的开放手术修复和TEVAR都与较高的手术死亡率有关。TEVAR和血脂异常是手术死亡率的风险因素。AEF仍需采取预防措施和进一步改进的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.

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