At the esophageal temperature of 26°C the circulation was stopped and cerebral and spinal protection was achieved by selective antegrade perfusion, while myocardial protection was achieved via cold crystalline cardioplegia in ante- and retrograde fashion. The arch was resected until the origin of the left subclavian artery, that was divided and whose origin was secured with two 4/0 prolene pledgeted stiches and a double running 4/0 suture.