Related Experiment Video
Updated: Apr 23, 2026
Author Spotlight: Development of a Minimally Invasive Large-Animal Model for Reliable and Reproducible Cardiovascular Research
Published on: October 20, 2023
Port access cardiac operations can be safely performed with either endoaortic balloon or Chitwood clamp
Pavan Atluri1, Andrew B Goldstone1, Jeanne Fox1
1Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Minimally invasive cardiac surgery using endoaortic balloons or Chitwood clamps for heart arrest shows similar low rates of vascular complications. Experience with endoaortic balloons can further minimize risks in these procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Minimally invasive, port access, right thoracotomy approaches for intracardiac operations are increasingly accepted.
- Standard cardioplegic arrest techniques include endoaortic balloons and Chitwood clamps.
- Concerns exist regarding vascular adverse events associated with endoaortic balloon occlusion.
Purpose of the Study:
- To evaluate the vascular risk associated with endoaortic balloon use compared to the Chitwood clamp.
- To assess the safety and efficacy of different aortic occlusion methods in minimally invasive cardiac surgery.
Main Methods:
- Retrospective analysis of patients undergoing minimally invasive, port access, right thoracotomy operations from 1998 to 2012.
- Comparison of vascular adverse events between patients undergoing aortic occlusion with an endoaortic balloon (n=875) and a Chitwood clamp (n=189).
Main Results:
- No statistical difference in dissection rates between endoaortic balloon (1.03%) and Chitwood clamp (1.06%).
- No significant difference in type A dissection rates (endoaortic balloon=0.57%, Chitwood clamp=1.06%, p=0.28).
- Identical incidence of stroke between the two methods (2.2% vs 2.1%, p=1.0).
Conclusions:
- Minimally invasive cardiac operations with peripheral cannulation are safe with either endoaortic balloon or Chitwood clamp aortic occlusion.
- Vascular adverse events can be minimized with either technique.
- Increased experience with endoaortic balloons can further reduce the incidence of vascular adverse events.
Background:
Minimally invasive, right thoracotomy (port access) approaches to intracardiac operations (mitral valve, tricuspid valve, atrial septal defect, intracardiac tumors) are becoming increasingly accepted by surgeons, cardiologists, and patients alike. Standard techniques for cardioplegic arrest of the heart have included endoaortic balloons and Chitwood clamps. Concerns have been raised regarding the potential increased risk of vascular adverse events (embolization, dissection, stroke, lower extremity ischemia) associated with endoaortic balloon occlusion. We undertook this study to evaluate the vascular risk associated with endoaortic balloon use.
Methods:
All patients undergoing minimally invasive, port access, right thoracotomy operations from 1998 to 2012 at our institution were retrospectively analyzed. Patients undergoing aortic occlusion with the Chitwood clamp (n=189) were compared with patients undergoing occlusion with the endoaortic balloon (n=875).
Results:
There was no statistical difference in the rate of dissection between patients undergoing aortic occlusion with an endoaortic balloon (1.03%) and those receiving a Chitwood clamp (1.06%). Similarly, there was no difference in the rate of type A dissection between aortic occlusion strategies (endoaortic balloon=0.57%, n=5, vs Chitwood clamp=1.06%, n=2, p=0.28). No difference in the incidence of stroke was identified between the endoaortic balloon and the Chitwood clamp (2.2% vs 2.1%, p=1.0).
Conclusions:
Minimally invasive cardiac operations using a peripheral cannulation strategy can be safely performed with minimal vascular adverse events incorporating either endoaortic balloon or Chitwood clamp aortic occlusion. As experience with the endoaortic balloon is gained, the incidence of vascular adverse events can be reduced to nearly negligible rates.
