Bentall operation is indicated when there is Aortic valve disease with aortic root aneurysm. If the Aortic aneurysm extends to the arch, concomitant Bentall operation plus Aortic arch replacement is required (COBAAR).

COBAAR is rare and challenging because of its complex cardiopulmonary procedure, prolonged Bypass surgical time, and demanding operative technique. Therefore, mortality and morbidity rates are high for COBAAR.

A 43-year-old patient attended with breathlessness for the last 3 months. On complete evaluation, the patient was having severe Aortic stenosis, severe Pulmonary Hypertension, Moderate Mitral regurgitation, and an aneurysm of ascending, and arch of the Aorta.

This patient underwent Aortic valve replacement along with the Aortic root, and the arch was replaced with St Jude Medical aortic valve and graft. The innominate artery, left carotid artery, and left subclavian arteries were reimplanted to Arch graft, with the help of femoral and right arterial Bypass with Delnedo cardioplegia and direct antegrade cerebral perfusion through carotid arteries.

The patient was ventilated for 48 hours and extubated with stable hemodynamics without any neurological deficit. He was discharged in stable condition after one week.

Even though COBAAR carries high risk, we were able to perform the surgery successfully and discharged the patient in stable condition. This can give long-term good results and avoid reoperation of residual aortic wall aneurysms.