Mini-access branch-first total arch replacement and frozen elephant trunk procedure.

Minimally-invasive surgery presents its own unique set of challenges, especially when applied to treatment of aortic arch disease. The key components of mini-access aortic arch surgery include safe circulatory control, adequate organ protection, and meticulous surgical technique. This article describes how to perform branch-first total arch replacement with the frozen elephant trunk (FET) procedure for distal arch aneurysms. The strategy employed offers the advantages of mini-access surgery, as well as sound cerebral and systemic organ protection strategies. 2020 Annals of Cardiothoracic Surgery. All rights reserved.