<p>Minimally invasive techniques in aortic surgery have steadily developed; however, although the isolated replacement of the ascending aorta via an upper hemisternotomy is well-established, so far there is only limited experience with minimally invasive procedures that also include the proximal aortic arch. Therefore, a retrospective evaluation of the treatment results of 86&#xa0;patients who underwent elective surgical replacement of the ascending aorta with (<i>n</i> = 40) or without (<i>n</i> = 46) concomitant proximal aortic arch replacement between 2009 and 2023 was carried out. The aim of the study was to examine the safety and feasibility of a minimally invasive approach with extension to the proximal aortic arch. As expected, the operating and bypass times were significantly longer in the extended intervention group. The duration of ventilation was also significantly increased in this group; however, despite the technically more demanding procedure with hypothermia and selective cerebral perfusion in the group with replacement of the proximal aortic arch, no increase in morbidity or mortality was observed. The duration of the intensive care unit (ICU) and hospital stays as well as the rate of postoperative complications showed no significant differences and the 10-year survival rates were comparable. The study showed that the minimally invasive approach with extension to the proximal aortic arch represents a&#xa0;safe and effective procedure and comparable results could be achieved. Therefore, the indications for minimally invasive aortic surgery can be extended to the proximal aortic arch and provide a&#xa0;gentle and simultaneously effective treatment option, especially for elective interventions.</p>