A 65-year-old gentleman with claudication underwent contrast-enhanced computed tomography. The scan showed occlusion of the infrarenal abdominal aorta and a 6.0 × 3.7 cm saccular zone-3 arch aneurysm. The left ventricular ejection fraction was 35% and a coronary angiogram revealed triple-vessel disease. In view of the patient's high risk with EuroSCORE II 20.34%, coronary artery surgery was combined with hybrid type I arch aneurysm repair. An endovascular stent was delivered in an antegrade manner. Open heart surgery and a hybrid type I arch intervention can be performed simultaneously through a midline sternotomy approach.
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