Aorto-cardiac fistula etiology, presentation, and management: A systematic review.

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.