A consecutive series of 16 patients over 75 years old who underwent aortic arch operations with hypothermic selective cerebral perfusion from 1994 to 1997 was analyzed. These patients (group O) was compared with 18 patients aged from 70 to 74-year-old (group M) and 38 patients under the age of 69 (group Y) who underwent aortic arch operation during the same period. There were 5 males and 11 females with a mean age of 77.8 years (range 75 to 86) in group O. Twelve patients were in aortic dissection and 4 patients were in atherosclerotic aneurysms. There were 5 hospital deaths (31.2%) in group O, 2 (11.1%) in group M and 2 (5.3%) in group Y. There was significant difference in hospital mortality rate between group O and group Y. Cerebral complication occurred in 2 patients (12.5%) and postoperative respiratory failure occurred in 7 (47%) in group O. Aortic arch operations for the elderly patients can be performed with increased but operative mortality in the elderly patients remains high. In this study, we discussed that influence of risk factors on the operative result and operative indication in the elderly patients.