During aortic arch reconstructive surgery, continuous coronary and antegrade cerebral perfusion (ACP) has been shown to provide optimal myocardial and cerebral protection. However, hypothermia alone without perfusion is frequently trusted for lower body protection. When prolonged, visceral and lower body ischemia can result in metabolic debt, leading to significant lactic acidosis and end organ dysfunction. Between January 2008 and April 2014 a single surgeon at London Health Sciences Centre performed 83 consecutive proximal aortic arch reconstructive surgeries requiring hypothermic circulatory arrest (HCA). All operations were performed using ACP and moderate hypothermia (21°C to 28°C). Forty-two patients had their surgery using only ACP and HCA. Forty-one patients had their surgery using a whole body perfusion (WBP) strategy (ACP, HCA, and additional lower body perfusion through femoral artery cannulation or direct descending aorta cannulation). Baseline characteristics, clinical outcomes, and metabolic data were analyzed. There were no significant differences in patient demographics or comorbidities between the 2 groups. The WBP group contained a significantly higher number of patients undergoing total arch reconstruction (56% versus 19%, p<0.01) with a concomitant need for significantly longer bypass time (268±79 versus 205±55 minutes, p<0.01), cross clamp time (203±60 versus 131±57 minutes, p<0.01), and HCA time (43±29 versus 30±15 minutes, p=0.01). Both groups contained a similar proportion of aortic dissections and emergent cases. Despite the complexity of surgeries performed in the WBP group, there was not a significant increase in intraoperative or postoperative peak lactate levels. Similarly, there were no differences in bicarbonate levels; however intra-operative pH values were significantly lower in the WBP group but recovered within hours of ICU admission (see figure). Use of platelets (39% versus 59%, p=0.06) and FFP (37% versus 69%, p<0.01) was less in the WBP group, as was ICU length of stay (mean 5 days versus 8 days p=0.01). There were no differences between the groups in terms of postoperative outcomes including death (4.9% versus 7.1%, p=0.67) and any of 10 major postoperative complications (27% versus 31%, p=0.68). Aortic arch reconstructive surgery can be safely performed using a WBP strategy that combines moderate HCA and ACP with additional lower body perfusion. The technique may reduce metabolic debt in more complex arch cases and may be contributory to a reduction in the use of blood products and ICU length of stay. Further study is warranted.