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

The review included almost only case reports and case series, not randomized or clinical trials. No formal quality assessment was performed because the records were mainly case reports. Non-English articles were translated with Bing translator, and the authors asserted the translations were reliable. Patients were not randomly assigned to treatment, so groups differed by cause, fistula size, and illness. Some studies lacked in-hospital or follow-up data, so survival at maximum follow-up cannot be conclusively interpreted. Mortality was all-cause and could not be attributed to the fistula or cardiovascular cause. No uniform procedural risk stratification was available, so percutaneous and surgical survival cannot be conclusively compared. Selection bias is inherent in a systematic review of published case reports.

No funding or conflict-of-interest statement appears in the supplied text; the publication types list NIH extramural support.

Do not read the survival percentages as proof that percutaneous closure is better. The review pooled case reports and case series, did not formally assess quality, and groups differed in cause and illness, so treatment choice was not random.