Acute Type A aortic dissection (ATAAD) is a condition associated with a mortality rate up to 26% and significant morbidity. Despite advances in numerous aspects of cardiac surgery a traditional approach of ascending aorta and “hemi-arch” replacement utilising deep hypothermic circulatory arrest (DHCA) and an open distal anastomosis persists for the management of this condition in most centres. We hereby describe the rationale behind our surgical approach of the branch-first total aortic arch replacement technique for the management of ATAAD.