One step thoracotomy approach for atrial-esophageal fistula repair without cardiopulmonary bypass

Although atrial-esophageal fistula is an extremely rare disease, it is a life-threatening complication after catheter ablation for atrial fibrillation. There is no consensus on management or repair for atrial-esophageal fistula which has a high mortality rate. Here, we describe a lateral thoracotomy approach focused on simplifying the repair procedure for atrial-esophageal fistula with two cases. Two male seniors in their 60s and 70s, respectively, who had undergone catheter ablation for atrial fibrillation presented to the emergency department with fever and mental decrease. Blood culture confirmed Streptococcal bacteremia. Brain magnetic resonance imaging showed multiple cerebral infarcts. After demonstrating atrial-esophageal fistula with computed tomography of chest, an emergency operation was planned. The two patients were placed in the right down decubitus position with single lung ventilation. A lateral thoracotomy was performed on the left 5th intercostal space. Multiple pledgeted 4-0 prolene sutures for ligation were paced on the fistula of the pericardial side. From the esophageal side, a fistulectomy was performed, followed by an additional primary repair for the esophageal defect. Follow-up endoscopy demonstrated a well-repaired fistula site. The two patients were discharged without recurrence. Our experience suggests that one step repair for atrial-esophageal fistula via lateral thoracotomy might be feasible in selected patients.