Operative procedure. A. The aorta was transected between the left subclavian artery and the left common carotid artery. A branched equine pericardial sheet was anastomosed to the transected aorta. B. The sides of the pericardial sheet were sutured continuously to form a cylinder. The third distal branch was cut to obtain adequate length and anastomosed to the left common carotid artery. The second middle branch was used as an inflow root of the cardiopulmonary bypass. The main roll graft was clamped, and antegrade perfusion was restored. C. The first proximal branch was anastomosed to the brachiocephalic artery. Finally, the proximal anastomosis was performed.