We have analyzed the operative results and the long-term prognosis of Stanford type A acute aortic dissections. Between 1981 and 1997, 57 patients underwent surgical repairs of acute type A aortic dissection. In the earlier period (1981-1990; n = 21), almost all the operations were performed under aortic cross-clamping with conventional cardiopulmonary bypass, while in the later period (1991-1997; n = 36), radical resections and graft replacements under open distal anastomosis with deep hypothermic retrograde cerebral perfusion (RCP) were performed in 24 patients (66.7%) and with selective cerebral perfusion in 3 (8.3%). The hospital mortality rates were 33.3% in the earlier period and 16.7% in the later period. Two (8.3%) of 24 patients employed RCP failed by preoperative rupture to pulmonary artery and myocardial infarction. Reoperations for enlargement of the remained false lumen were performed in 4 in the earlier period, of whom 2 patients were dead. In the later period, 7 patients were reoperated on, and all patients survived. Over all actuarial survival rates were 57.1% at 5 year and 44.4% at 10 year in the earlier period, while it was 70.7% at 5 year in the later group. We concluded that retrograde cerebral perfusion allows resection of the dissected aorta including primary entry as well as open distal anastomosis, which contributes to the improvement of early and long-term results for acute type A aortic dissection.