Results of emergent surgery for acute Stanford type A aortic dissection are still poor. We reviewed our cases to find out how we could ameliorate surgical results. In the past five years, 36 patients with type A aortic dissection underwent emergent surgery. The operation was started within six hours from the onset of symptoms in 16 patients. The extent of aortic replacement was just beyond the entry-bearing portion. The operation was performed with the aid of open distal anastomosis and selective cerebral perfusion. Operative death occurred in one patient. Postoperative complications developed frequently. Respiratory failure, renal dysfunction and low cardiac output syndrome were most frequent. Their co-risk factor was perioperative bleeding which was related to young age, long operation time, arch replacement, additional procedure and failure of the entry site resection. Some modification of the suturing method might reduce hemorrhage. Prompt surgery following the diagnosis and appropriate selection of surgical tactics and anastomosis technique in order to reduce bleeding is essential to improve surgical results of acute type A aortic dissection.