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Age is still considered a risk factor in the repair of acute type A aortic dissection. Instead of total arch replacement, we performed hemiarch or partial arch replacement with intimal tear exclusion to reduce death in elderly patients and evaluated early-term and midterm outcomes.From January 2004 to April 2012, 59 patients older than 70 years (mean age, 77.0 ± 4.3 years) underwent emergency operations for acute type A aortic dissection at our institution. We performed hemiarch, partial arch, or total arch replacement, according to the location of the primary entry tear. The characteristics, surgical procedures, and early-term and midterm outcomes of these patients were reviewed.We performed hemiarch replacement in 47 patients, partial arch replacement in 4, and total arch replacement in 8. The primary entry site was excluded in 56 of 59 patients (94.9%). In-hospital mortality was 6.8%, and neurologic impairment occurred in 25.4%. We obtained midterm outcomes for 55 of 59 patients, with a mean follow-up period of 43.9 ± 23.7 months. Fourteen patients died, two of these of aortic-related causes. One patient required repeat aortic operation for rupture of a pseudoaneurysm. Follow-up computed tomography imaging was done in 28 of 55 patients during the 12 months after the operation. No significant difference was noted in the increase in maximal aortic diameter between patients with and without residual dissection.In-hospital mortality was 6.8%; relatively low compared with previous reports. Hemiarch and partial arch replacement with entry tear exclusion may reduce deaths associated with acute type A aortic dissection repair in elderly patients, without increasing the risk of reoperation and aortic-related death.