Background. Optimal management of patients with acute type aortic dissection is not clear. The clinical experience with total arch replacement combined with stented elephant trunk technique in the treatment of acute type B aortic dissection involving the aortic arch was analyzed. Methods. From January 2006 to April 2011, 24 consecutive patients with acute type B aortic dissection involving the aortic arch underwent total aortic arch replacement with stented elephant trunk implantation. Concomitant procedures included the Bentall procedure in 3 patients, David procedure in 1 patient, and ascending aortic replacement in 7 patients. Results. The times of cardiopulmonary bypass and selective cerebral perfusion averaged 168 +/- 41 and 21 +/- 4 minutes, respectively. One patient died of multiorgan failure 3 days after surgery. Complications occurred in 3 patients (3 of 24; 12.5%), including hoarseness and mediastinal bleeding requiring reoperation, each in 1 patient. One patient experienced transient consciousness dysfunction. The in-hospital mortality was 4.1% (1 of 24). No paraplegia occurred postoperatively. Follow-up was available in 22 patients (22 of 23; 95.7%). During the follow-up, 1 patient died of massive gastrointestinal bleeding 2 months after surgery. Type II endoleak occurred in 1 patient. One patient underwent thoracoabdominal aortic replacement 14 months after surgery. The complete thrombosis ratio of the false lumen was 86.4% (19 of 22) 6 months after surgery. The 5-year survival was 91.7%. Conclusions. Total arch replacement combined with stented elephant trunk technique was safe and feasible for acute type B aortic dissection involving the aortic arch. A low rate of morbidity and mortality and a satisfactory 5-year survival rate were achieved, as well as improved thrombosis of the false lumen. (Ann Thorac Surg 2012;93:1517-23) (C) 2012 by The Society of Thoracic Surgeons