Surgical dissection, Y-graft placement and positioning. Surgical procedure: after redo sternotomy, the ascending aorta and the aortic arch with its branches are dissected (a). As proximal as possible, a Y-shaped prostheses is anastomosed end-to-side at the ascending aorta prostheses (b). Distal anastomoses to the brachiocephalic trunk (end-to-side), the left carotid artery (side-to-side) and the left subclavian artery (end-to-side) (c; patient #2). Cartoon showing the surgical anastomosis to the aortic prosthesis (d); 1: Aortic Prosthesis from previous surgery, 2: New, secondary aortic pathology (i.e. aneurysm, re-dissection), 3: Y-graft, 4: Stentgraft.