Purpose Traditional surgical treatment of patients with heritable thoracic aortic disease (HTAD) requires open reconstruction. Hybrid aortic repair combines modified open arch operations with thoracic endovascular aortic repair (TEVAR). The GORE® thoracic branched endoprosthesis (TBE) facilitates hybrid operations by providing a reproducible, secure platform to reconstruct the aortic arch and proximal descending aorta, simplifying subsequent open thoracoabdominal (TAA) repair. Methods Four Pacific Islander patients with HTAD and prior ascending aortic repair for Type A dissection underwent staged total aortic replacement consisting of three procedures: 1) redo sternotomy and proximal arch reconstruction, 2) endovascular distal arch/ descending thoracic aortic with TBE and TEVAR extension, and 3) open TAA repair. The first two procedures were performed during a single hospitalization; the third operation was performed during a scheduled second hospital admission. Results All patients survived total aortic reconstruction. The mean interval between the first two procedures was 4.5 days (range 3-6 days). The mean interval to the third operation was 10.5 weeks (range 5-15 weeks). No patient sustained stroke or spinal cord injury. One patient had a prolonged spinal headache. Follow-up CT angiography was performed prior to discharge and showed good stability of the endovascular components. One patient developed late type IC endoleak from the left subclavian artery requiring subclavian to carotid arterial transposition and exclusion of the portal utilizing a traditional TEVAR for resolution. Conclusions This study demonstrates total staged hybrid aortic reconstruction is a safe and effective strategy for treatment of extensive aortic disease in Pacific Islander patients with HTAD. A single branched endograft is a key component that provides a stable platform for both proximal and distal extension and reduces the overall risk of neurologic injury.