Figure 1

Modified total arch replacement procedures. A Skeletoned elephant trunk was implanted; B The distal end of the prosthetic graft was anastomosed to the transected aorta wall in a sandwich-like fashion and low-body was reperfused; C The left common carotid was anastomosed and reperfused; D The proximal end of the graft was anastomosed and the perfusion of myocardium was resumed: E-F The innominate and left subclavian arteries were anastomosed.