Successful replacement of ascending and proximal transverse aorta for a 90-year-old female with aortic dissection was achieved using selective cerebral perfusion with cold blood. The ascending aorta enlarged as a diameter of 7 cm and massive blood flow was recognized in the false lumen detected by CT scanning and echocardiography. After the core cooling by cardiopulmonary bypass (CPB), the branches of the aortic arch were cannulated and perfused with cold blood (16 degrees C) for cerebral protection. The time of CPB, cardiac arrest and selective cerebral perfusion was 153 min, 92 min and 35 min, respectively. Post operative course was uneventful. She discharged from the hospital 4 weeks after the operation.