One-hundred-one surgeries for aortic arch aneurysm were divided into 2 groups: 52 aortic dissection cases (AD) and 49 non-dissecting aneurysm (TA). In group AD, 30 cases were operated in acute phase (acute AD) and 22 were in chronic phase (chronic AD). Preoperative shock were observed in 21 cases (15 in acute AD mostly due to cardiac tamponade, 1 in chronic AD and 5 in TA due to rupture). Through median sternotomy, 59 total arch replacement and 25 hemi-arch replacement were carried out under deep hypothermia (16 degrees C:DH) and retrograde (RCP) or selective (SCP) cerebral perfusion or arch-first technique. Through thoracotomy, distal arch replacement were carried out with DH + RCP in 8 cases and with partial bypass in 9. Early mortality were observed in 7 patients (6.9%) and 24 months survival rates (Kaplan-Meier) were 86.1% overall, 76.1% in acute AD, 95.5% in chronic AD, 87.8% in TA. The survival rates in patients with preoperative shock was 61.2%, however, without shock, 92.9% in acute AD, 95.2% in chronic AD, and 91.4% in TA. Other than mortality, 4 re-operations for aortic arch, 4 operations for descending to abdominal aorta and 1 late hemiplegia were observed. Aortic event free ratio at 24 months was 55.4% in acute AD, 94.4% in chronic AD, and 75.7% in TA. For the further improvement of aortic arch surgery, early mortality and residual false lumen in acute aortic dissection and atherosclerotic aneurysm in descending to abdominal aorta are focused.