The potential risks of deep hypothermic circulatory arrest in aortic arch surgery have been well documented. Antegrade cerebral perfusion may ameliorate brain injury but still involves variable periods of cerebral and visceral ischaemia. We describe a novel “branch-first continuous perfusion” technique which avoids both deep hypothermia and circulatory arrest. This brings us closer to the goal of arch surgery without cerebral or visceral ischaemia and the morbidity of deep hypothermia.