A technique of using a triple-lumen balloon catheter for occlusion of the ascending aorta in patients with distal aortic arch aneurysm during open proximal anastomosis utilizing hypothermic retrograde cerebral circulation technique through left thoracotomy was described. The balloon greatly facilitated (1) occlusion of the ascending aorta without cross clamping, (2) delivery of cardioplegic solution, (3) suctioning blood pooled in the aortic arch, and (4) prevention of entrance of debris into the left ventricle or coronary arteries.