We present our initial experience in 5 patients for open aortic arch repair with continuous antegrade perfusion of the brain and of the lower body by means of direct cannulation of the right axillary artery and of the descending aorta with a venous cannula (DLP 91037 cannula [Medtronic Inc, Minneapolis, MN]) for systemic perfusion under mild hypothermia (30 degrees C). This mode of perfusion allows safe open repair of the aortic arch, short aortic cross clamping, and CPB times associated to all the known advantages of the mild hypothermia; this technique could have the potential to be generally applicable in surgeries for aortic arch repairs after further evaluation.