This video demonstrates the total aortic replacement in a patient with Marfan's syndrome. The 2-stage elephant trunk procedure was used. A 48 year old woman with Marfan syndrome and who is status-post replacement of her ascending aorta due to Type A aortic dissection presented with extensive aortic aneurysm. She underwent replacment of the aortic root, ascending, and transverse aortic arch using the multi-branched arch graft with the adjuncts of integrated cerebral perfusion with the first stage Elephant trunk. Her extent II thoracoabdominal aortic aneurysm was repaired 6 weeks after the first stage using the second stage of the Elephant trunk procedure. She awoke neurologically intact and was discharged in good condition from both procedures. This video illustrates successful total aortic replacement of a patient with Marfan's syndrome.