Tianne J Foster1, Ali Hama Amin2, Tatiana Busu1, Kinjan Patel1, Peter Farjo1, Abdulrahman Al Hallak3, Nyaz Ali4, Mohamad Alkhouli5. 1. Division of Cardiovascular Disease, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA. 2. Section of Cardiology, Carilion Clinic, Virginia Tech-Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA. 3. West Virginia University Health Science Center, 1 Medical Drive, Morgantown, WV 26505, USA. 4. Department of Pediatrics, Carilion Clinic, Virginia Tech-Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA. 5. Division of Cardiovascular Disease, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN. Electronic address: Alkhouli.Mohamad@mayo.edu.
Abstract
BACKGROUND: Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce. METHOD: The authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies. RESULTS: 3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p = <0.00001). CONCLUSIONS: This systematic review sheds light on this highly morbid condition. Once recognized, fistula closure appears to be superior to conservative management.
BACKGROUND: Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce. METHOD: The authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies. RESULTS: 3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p = <0.00001). CONCLUSIONS: This systematic review sheds light on this highly morbid condition. Once recognized, fistula closure appears to be superior to conservative management.
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