Thoracic aortic aneurysm (TAA) poses a silent and potentially deadly threat to those who harbor them. Clinicians ought to maintain a high index of clinical suspicion for patients with a possible TAA and offer prompt preemptive surgical intervention before devastating complications occur. An important objective in surgery is to reduce surgical trauma and achieve faster recovery for our patients. This chapter describes the technical details on how I perform minimally invasive aortic surgery via a mini-sternotomy access. The operation consists of 6 major steps: 1) mini-sternotomy, 2) cannulation, 3) aortic root exposition, 4) ‘French Cuff’ technique or double layer anastomosis, 5) coronary buttons re-implantation and 6) hemi-arch replacement. The success of the operation is a direct result of careful completion of these steps. The details of the ‘French Cuff’ technique are described in this chapter to show how to improve the hemostasis along the proximal annular anastomosis.