Abstracts DGCH

Background:Lore Although rare, aorto-esophageal fistula (AEF) remains one of the most critical diseases in cardiovascular surgery.With thoracic endovascular aortic repair (TEVAR) establishing itself as a standard treatment for pathologies of the descending aorta, the number AEF cases manifesting secondarily is rising.The lack of prospective studies or even large case series leads to an absence of evidence based therapeutic concepts. Materials and methods:We conducted a retrospective analysis of all patients treated at the University Hospital of Munich LMU for aorto-esophageal fistula (AEF) between September 2014 and May 2023 (n = 10).Additionally, a systematic search was conducted for all studies researching treatment of AEF including 5 patients and published within the last 10 years. Results:In the LMU patient-collective 40 % of manifested as primary AEF (due to thoracoabdominal aneurysm, esophageal cancer), while 60 % occurred secondary to previous TEVAR.Mean duration to manifestation post-TEVAR was 20.1 5.6 months.Short term mortality within 30 days across the whole collective was 40 % (due to acute bleeding, fulminant sepsis).Initial treatment of the aorta consisted of rifampicin soaked TEVAR or TEVAR-relining in n = 7 cases, followed by bovine open aortic replacement (n = 1) or bovine patchrepair (n = 1) when viable.When possible, treatment of the esophagus consisted of primary suture (n = 1) or esophagectomy (n = 5) with gastric pull-up or colon interposition.Patients receiving esophagectomy or esophageal repair exhibited significantly longer survival (12.8 4.7 vs 0.35 1.3 months, p = 0.019).Across the reviewed literature, the strongest effect on survival seems to originate from surgical treatment of the esophagus, however, some groups report best single outcomes using maximally aggressive surgical treatment of both esophagus and aorta.Specific surgical strategies as well as patient characteristics vary widely. Conclusion:We found TEVAR effective in stabilizing the initial symptoms and viable as definitive aortal treatment with acceptable mid-term outcomes.Short interval esophagectomy seems to improve outcome by mitigating prothesis infection and should be considered in all patients.Open aortic replacement with stent removal should be performed when viable with respect to patient comorbidities.Interventional treatment options alone do not appear to be sufficient.