Evolving techniques in aortic arch surgery have improved patient outcome.We reviewed contemporary outcomes in a large single centre series of patients undergoing aortic arch replacement.Methods.A database search of all patients who underwent aortic arch surgery was performed.Clinical outcome was retrospectively analysed.Results.Between January 2003 and November 2009, 647 patients underwent aortic arch replacement surgery (mean age 62+/-14 years, 64% male).In 30% the underlying disease was an acute type A aortic dissection, while 70% (n=456) were operated on for aortic arch aneurysm.Sixteen percent of patients had previous cardiac surgery.Total arch replacement was performed in 27% and partial arch replacement in 73%.Mean bypass time was 200.6+/-81.5 min, and mean X-clamp time 108+/-5 1min.Thirty-day mortality in all patients was 11%.Patients with acute aortic dissection had a thirty-day mortality of 17% (9% for patients without type A dissection).Follow-up was obtained on 100% of patients with a mean follow-up of 4.8+/-0.1 years (range: 0 to 6.4 years).Six-year survival was 68%.Conclusions.These data demonstrate excellent clinical outcome of patients undergoing aortic arch surgery.Acute type A aortic dissection was associated with a almost two-fold higher perioperative mortality compared to elective cases.