We have developed an antegradely insertable aortic balloon occlusion
catheter for aortic arch repair, and review our experiences of using it. The purpose of the present study was to examine the usefulness of the balloon for surgical treatment of
aortic arch aneurysm. In 30 patients with
aortic arch aneurysm, including 22 with a non-ruptured and 8 with a
ruptured aneurysm, the
catheter was antegradely inserted into the descending thoracic aorta through the aortic arch or the
aneurysm without opening the pleural space after establishing antegrade selective cerebral perfusion and obtaining
cardiac arrest. During distal anastomosis, the
catheter occluded the aorta with continuous perfusion of the lower half of the body through an arterial
cannula inserted into the femoral artery. Among the patients with a nonruptured
aneurysm, two deaths (9.1%) occurred because of aorto-broncho-esophageal fistulae or
cardiac arrest due to severe
asthma attack within 30 days, and the other three hospital deaths were due to
aspiration pneumonia,
multiple organ failure with preoperative renal dysfunction, or
low cardiac output syndrome due to perioperative
myocardial infarction. Among the patients with a
ruptured aneurysm, three deaths (37.5%) were due to acute
myocardial infarction,
respiratory failure, or intractable
arrhythmia within 30 days, and another hospital death was caused by
mediastinitis. No
paraplegia was caused in any patient excluding one of the patients with a
ruptured aneurysm who could not be weaned from the
extracorporeal circulation due to perioperative
myocardial infarction. There was no early postoperative serious visceral organ dysfunction except for two patients with postoperative
low cardiac output syndrome or preoperative severe renal dysfunction. This
catheter was effective in protecting the visceral organs and the spinal cord in the repair of an
aortic arch aneurysm.