Objective To summarize the clinical experience of using modified elephant trunk aortic arch replacement for Stanford type A aortic coarctation involving the aortic arch. Methods From July 2005 to April 2011, 39 patients with Stanford type A aortic coarctation involving the aortic arch were treated with modified elephant trunk aortic arch replacement at the Department of Cardiac Surgery, Qilu Hospital, Shandong University, including 25 males and 14 females, with ages ranging from 32 to 66 years old, with an average of (43±12) years old. There were 29 cases of acute coarctation, 10 cases of chronic coarctation, 8 cases of severe aortic valve insufficiency, 12 cases of pericardial effusion, 6 cases of pleural effusion, and 22 cases of hypertension. Preoperative cardiac color Doppler ultrasound and CT examination were routinely performed to clarify the nature and degree of aortic valve lesions, and the location and extent of the intimal rupture of aortic coarctation.39 patients were diagnosed as Stanford type A aortic coarctation, with intimal rupture of the ascending aorta and the arch of the aorta.6 patients underwent emergency surgery, and the rest of the acute detachment cases were operated on a deadline as soon as possible, and those with chronic coarctation had a near-term operation. The 38 cases of primary surgery were operated with sedation anesthesia, systemic deep hypothermia (early cooling to an anal temperature of 18oC, after 2009 cooling to nasopharyngeal temperature of 18oC~20oC), right axillary artery cannulation of the lower half of the body to stop the circulation plus low-flow selective right-sided cerebral perfusion. Intraoperatively, the right axillary artery was cannulated with a single pump and two tubes, and the upper and lower half of the body were perfused separately during the operation through the perfusion branch of the four-branch artificial vessel and the right axillary artery cannulation. The anastomotic sequence of the three major branches of the aortic arch was, in the early stage, anastomosed to the left subclavian artery first, which was later changed to anastomose the left common carotid artery first. Six cases of Bentall’s operation (one case of coronary artery bypass grafting in the same period) and two cases of aortic valvuloplasty were performed in the same period. There was 1 case of secondary surgery, 8 years after ascending aortic replacement, who underwent modified elephant trunk aortic arch replacement + Bentall surgery again; during the operation, axillary artery cannulation was used, bilateral femoral vein cannulation was used, in order to prevent aneurysm rupture and hemorrhage, the aneurysm was first cooled down to the anus temperature of 18oC, and then after stopping the circulation and splitting the sternum, then started the extracorporeal circulation, and the above steps of the operator were repeated to complete the operation. Results The duration of extracorporeal circulation ranged from 135 to 268 min, with an average of (179.8±47.6) min, the duration of aortic blockage ranged from 67 to 157 min, with an average of (103.5±24.2) min, and the duration of deep hypothermic shutdown ranged from 24 to 128 min, with an average of (48.2±21.9) min. The amount of perioperative blood transfusion (erythrocytes and plasma) ranged from 800 to 6400 ml, with an average of (48.2±21.9) min. 6400 ml, mean (1685±1309) ml. 5 cases of cerebral complications (2 cases were cured and discharged from the hospital, 2 cases died, and 1 case was automatically discharged from the hospital), 4 cases of renal failure (2 cases of hemodialysis, 2 cases of peritoneal dialysis, 2 cases of survival and 2 cases of death), and 2 cases of respiratory failure with no deaths were found after the operation. Follow-up from 1 to 4 years, 34 cases survived, and all of them returned to normal life. The incidence of postoperative brain damage decreased significantly in the last two years, while there was no significant decrease in cases of renal failure. Conclusion Deep hypothermic arrested circulation (DHCA ), selective cerebral perfusion (SCP), and modified elephant trunk aortic arch replacement are reliable in the treatment of Stanford type A aortic coarctation, and should be operated as soon as possible after the diagnosis is clear. Recently, cerebral complications have decreased significantly, and postoperative renal failure is the main complication that should be prevented and treated; for patients with pericardial effusion and other indications of emergency, hepatic impairment is not an absolute contraindication to surgery.