BACKGROUND In aortic dissection, patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of an open distal anastomosis under retrograde cerebral perfusion. METHODS During a 15-year period (1981-1995), 51 patients with type A dissection underwent 59 surgical repairs. In 1990, a distal open anastomosis with retrograde cerebral perfusion (group II) was introduced to replace the aortic cross clamp method (group I). Mean retrograde cerebral perfusion time was 50 minutes (range 22 to 65 minutes) with no neurologic sequelae in surviving patients. RESULTS Operative mortality was 28.6% in group I, and 16.1% in group II. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 56.2% (9/16) in group I, and 4 patients died of aortic rupture. There was no mortality in group II, and dilatation of the distal false lumen occurred in only 15.3% (p<0.05). CONCLUSIONS Use of retrograde cerebral perfusion in aortic dissection allowed for adequate time to perform a safe, open, distal anastomosis. Intraoperative cerebral complications and enlarged patent false lumens decreased significantly.