AI Article Synopsis
- Endoaortic inflatable balloons were tested as a potential alternative to cross-clamping the aorta during surgeries to minimize vessel injury and debris displacement, but their safety and effectiveness were uncertain.
- In a study of 2,172 patients, 52 underwent endoaortic occlusion, but 19.2% of these required a switch back to traditional techniques due to issues like incomplete occlusion or balloon failure.
- The results showed a significantly higher rate of in-hospital deaths (25%) and a possible increase in stroke risk (3.8%) among patients using endoaortic occlusion compared to standard procedures, raising concerns about its overall efficacy.
Article 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.
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| http://dx.doi.org/10.1016/j.athoracsur.2006.05.113 | DOI Listing |
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