fig1

Figure 1. Procedure of total arch replacement with the frozen elephant trunk technique. The frozen elephant trunk was inserted through the transection site into the intended distal landing portion by guiding transesophageal echocardiography. We constructed the distal anastomosis with a separated 4-branched graft and antegrade systemic circulation was restarted through the side branch of the graft. The left common carotid artery and brachiocephalic artery were then anastomosed to their respective graft branches. After completion of the proximal anastomosis, the aortic graft was declamped and the 8 mm graft connected to the left subclavian artery was finally anastomosed with one branch of the graft