An easy and useful exposure technique using a malleable ring for the distal anastomosis in total arch replacement.

Even if the thoracic endovascular aortic repair or open stent grafting technique becomes popular, surgical total arch replacement is still important and will continue to be necessary. Distal anastomosis of total arch replacement is critical in this procedure. This article describes an easy and useful method for using a malleable retractor ring in the distal anastomosis of the total arch replacement.