Between January 1991 and February 1993, 14 patients (3 female, 11 male) aged between 21 and 79 years (mean 50 years) underwent reconstruction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, in 3 patients coronary artery by pass grafting was performed before. All patients were operated using cardiopulmonary bypass with continuous blood cardioplegia, hypothermic circulatory arrest (11 degrees C nasopharyngeal temperature, 0-EEG) and posterolateral exposure. All patent lower intercostal and lumbar arteries (Th3-L5) were reimplanted. The 30-day mortality after repair of the thoracic aorta was 0, after replacement of the thoracoabdominal aorta 28.5% (n = 2). One patient died 70 days after replacement of the thoracic aorta as a consequence of a perioperative stroke. None of the surviving 11 patients developed a permanent neurologic deficit, renal or cardiac dysfunction. The average intensive care stay was 6 days for patients after replacement of the thoracic and 18 days for patients after replacement of the thoracoabdominal aorta. Our results indicate the method of elective hypothermia and circulatory arrest effective in spinal cord protection. The increase in the tolerable duration of spinal cord ischemia supports the reimplantation of all intercostal and lumbar vessels.