A new staged hybrid total arch repair procedure using a branched proximal elephant trunk technique with implantation of stent grafts to the ascending aorta.

We report a new hybrid aortic arch repair procedure for the treatment of extensive thoracic aortic aneurysms involving the ascending aorta, arch, and descending aorta. In the first stage of this procedure, a "double-barrel tube graft" was inserted into the ascending aorta and fixed to the sinotubular junction under short-duration cardiopulmonary bypass in normothermia. In the next stage, after debranching of the left common carotid artery and left subclavian artery, stent grafts were deployed from the double-barrel tube graft to the descending aorta and the brachiocephalic artery to exclude the aneurysms. The patient's postoperative course was uneventful, with no endoleaks. The successful initial result suggests that this procedure could be an attractive treatment option for extensive aortic aneurysms.