BACKGROUND: The open anastomosis technique is a classic procedure for treating extended ascending aortic aneurysms, but hypothermic circulatory arrest is unavoidable, which increases the risk of organ injury. The aortic arch-clamping (AAC) technique is an alternative treatment. This study aimed to evaluate the efficacy of the AAC technique in patients with ascending aortic aneurysms extending to the proximal arch. METHODS: From January 2015 to February 2022, 230 patients with ascending aneurysms extending to the proximal arch underwent surgical intervention. Based on the type of distal ascending aorta surgery, the patients were divided into the AAC group (n=117 cases) and the open distal anastomosis (ODA) group (n=113 cases). The prognosis of 67 matched pairs was compared after 1:1 propensity score matching (PSM). RESULTS: After PSM, the baseline data were similar between the AAC and ODA groups. In the AAC group, the cardiopulmonary bypass duration was significantly lower (median 120 CONCLUSIONS: Considering its short- and mid-term efficacy, the AAC technique is an alternative technique for extended ascending aneurysms.