OBJECTIVES: To identify the risk factors for hypoxaemia following surgical repair of acute type A aortic dissection. METHODS: This was a retrospective study of patients treated between October 2013 and December 2014 at the Department of Cardiovascular Surgery, Anzhen Hospital, China. Univariable and multivariable analyses were performed on the clinical data of 160 patients with acute type A dissection and who underwent ascending aortic and arch replacement under deep hypothermic circulatory arrest. RESULTS: Hypoxaemia occurred in 30% (48/160) of patients (age: 49 +/- 7.9 years; 40 males, 83.3%). The duration of ventilation and the lengths of intensive care unit and hospital stays were significantly longer in patients with hypoxemia (77.9 +/- 56.0 vs 16.5 +/- 11.5 h, P < 0.0001; 6.0 +/- 2.3 vs 2.0 +/- 1.2 days, P = 0.001; 18.1 +/- 6.3 vs 13.5 +/- 4.7 days, P = 0.0012; respectively). The difference in operative mortality was not statistically significant between the hypoxaemia and non- hypoxaemia groups ( 6.25% vs 3.57%, P = 0.351). The independent risk factors of postoperative hypoxaemia were time from symptom onset to surgery = 72 h [odds ratio, 3.63; 95% confidence interval, 1.3110.02; P = 0.013], preoperative PaO2/FiO(2) < 300 (odds ratio, 15.30; 95% CI, 5.52-42.43; P < 0.001), preoperative white blood cell count > 15 000/ mu l ( odds ratio, 9.79; 95% CI, 2.47-38.87; P = 0.001); and deep hypothermic circulatory arrest time > 25 min (odds ratio, 3.26; 95% CI, 1.18-8.99; P = 0.023). CONCLUSIONS: Time from symptom onset to surgery = 72 h, preoperative PaNO2/FiO(2) = 300, white blood cell count > 15 000/mu l and deep hypothermic circulatory arrest time > 25 min were found to be independently associated with hypoxaemia after surgery for acute type A aortic dissection.