title: Surgical management of the atherosclerotic ascending aorta: is endoaortic balloon occlusion safe?
abstract: BACKGROUND
  Occlusion of the atherosclerotic ascending aorta by an endoaortic inflatable balloon has been proposed as an alternative to conventional cross-clamping to prevent injury to the vessel and distal embolization of debris. The safety and the effectiveness of endoaortic occlusion have not been documented in this setting.
  
  
  METHODS
  Endoaortic occlusion was employed in 52 of 2,172 consecutive patients. Surgeon's choice was based on preoperative identification of aortic calcifications or intraoperative epiaortic ultrasonographic scanning. Deaths and strokes were analyzed casewise and in aggregate.
  
  
  RESULTS
  In 10 patients (19.2%), the endoaortic balloon had to be replaced by the ordinary cross-clamp because of incomplete occlusion (n = 5), hindered exposure (n = 2), or balloon rupture (n = 3). In-hospital death occurred in 13 patients (25%), and stroke on awakening from anesthesia in 2 (3.8%). The death rate of patients treated by endoaortic occlusion was significantly higher compared with all other patients (4.2%, p < 0.0001) and with the expected estimate by European System for Cardiac Operative Risk Evaluation (10.5%, p = 0.05). By multivariable analysis, use of endoaortic occlusion was independently associated with in-hospital death (odds ratio = 5.609, 95% confidence interval: 2.684 to 11.719). Although the stroke rate was higher in the endoaortic occlusion group compared with all other patients, the difference was only possibly significant (3.8% versus 0.8%, p = 0.067).
  
  
  CONCLUSIONS
  In this series, the endoaortic occlusion was frequently ineffective, and was associated with a significantly higher risk of in-hospital death and a numerically higher risk of stroke.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. bartolo.zingone@aots.sanita.fvg.it
authors.forename: Bartolo
authors.initials: B
authors.lastname: Zingone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rauber
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Benussi
authors.forename: Lorella
authors.initials: L
authors.lastname: Dreas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D050197:Atherosclerosis / Q000601:surgery*; D021721:Balloon Occlusion / Q000009:adverse effects* / Q000401:mortality; D003250:Constriction; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome