Background: The stented elephant trunk with arch replacement became the first choice for Debakey I acute aortic dissection. Many patients received the concomitant aortic prosthetic replacement and were required to be anticoagulated with warfarin sodium. That is possible to be brought the adverse influence on the residual false lumen in distal aorta. Methods: Two patients with Debakey I acute aortic dissection underwent open stented elephant trunk procedure with arch replacement. One patient received aortic valve replacement (AVR) with mechanical valve and another without AVR. Results: The patient with AVR whose computed tomography (CT) showed fast ectasis in descending aorta was undergone the thoracoabdominal replacement 2 years later. Another without AVR was free from reoperation on distal aorta nearly 10 years. His CT image showed complete thrombosis of false lumen and perfect healing of residual dissection at following up. Conclusions: The warfarin sodium anticoagulation maybe have an adverse influence on the false lumen fate in residual dissection after the stented elephant trunk surgery.