Operative technique of acute type A aortic dissection remains controversial. We adopted the strategy to replace the aortic arch only when the entry of the dissection was found in the aortic arch, or atherosclerotic arch aneurysm existed. The purpose of the current study was to elucidate the feasibility of the ascending aorta and hemiarch replacement and to follow the fate of the patent false lumen distal to the anastomosis after surgery. Nineteen patients operated from 2000 to 2004 were included in this study. Ascending or hemiarch replacement were performed in 15/19 (78.9%) patients. The early mortality rate was 10.5% (2/19). The causes of death included major brain infarction and rupture of the descending aortic aneurysm 25 +/- 23 days after surgery. Thrombosed distal false lumen of the thoracic aorta was observed in 60% (9/15) of patients of De Bakey type I dissection. Thus our strategy for acute type A aortic dissection including entry closure and the ascending or hemiarch replacement is a reasonable option especially for the elderly patients in acute phase. Our results also indicated that the thrombosis of the false lumen distal to the anastomosis can be expected and the enlargement of the distal aorta is minimal.