Establishment of a feasible surgical strategy for aortoesophageal fistula

IF 2.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques Pub Date : 2026-10-01 Epub Date: 2026-07-10 DOI:10.1016/j.xjtc.2026.102502

Katsuhiro Yamanaka MD, PhD, Kenji Okada MD, PhD, Kazunori Sakaguchi MD, Tasuku Okada MD, Hironaga Shiraki MD, Ryo Kawabata MD, Jun Karaki MD, Yasufumi Koterazawa MD, PhD, Noriko Oyama MD, PhD, Soichiro Henmi MD, PhD, Hironobu Goto MD, PhD, Hiroaki Takahashi MD, PhD, Yutaka Okita MD, PhD

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Abstract

Objectives

Aortoesophageal fistula (AEF) represents one of the most challenging and devastating complications in aortic surgery. This study aimed to evaluate the feasibility, technical considerations, and clinical outcomes of our standardized multidisciplinary strategy for AEF, which has been consistently applied since 2008.

Methods

This retrospective study included 21 patients with AEF who underwent open surgery from January 2008 to September 2025. The primary end point was freedom from infection-related death, reflecting the central role of infection control in AEF management. Secondary end points included hospital mortality, overall survival, and the esophageal reconstruction rate.

Results

The mean age was 69.3 ± 11.2 years. Hospital mortality after open surgery was 26.9%. The 10-year overall survival and freedom from infection-related death were 38.4 ± 13.2% and 89.7 ± 6.8%, respectively. After implementation of our current standardized strategy in 2008, no recurrent infections were observed, and 10 patients successfully completed reconstruction.

Conclusions

Although hospital mortality remains substantial, long-term outcomes were favorable. The current multidisciplinary surgical strategy was associated with improved infection-related outcomes, with no recurrent infections observed.

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建立可行的主动脉食管瘘手术治疗策略

目的主动脉食管瘘（AEF）是主动脉手术中最具挑战性和破坏性的并发症之一。本研究旨在评估自2008年以来一直应用的AEF标准化多学科策略的可行性、技术考虑和临床结果。方法回顾性研究21例2008年1月至2025年9月行开放手术的AEF患者。主要终点是无感染相关死亡，反映了感染控制在AEF管理中的核心作用。次要终点包括医院死亡率、总生存率和食管重建率。结果患者平均年龄69.3±11.2岁。开放手术后住院死亡率为26.9%。10年总生存率和无感染相关死亡分别为38.4±13.2%和89.7±6.8%。在2008年实施我们目前的标准化策略后，没有观察到复发感染，10名患者成功完成重建。结论：虽然住院死亡率仍然很高，但长期结果是有利的。目前的多学科手术策略与改善感染相关的结果相关，没有观察到复发感染。

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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