ObjectiveRecent reports challenged the efficacy of retrograde cerebral protection, but there is still controversy about the best method of cerebral protection. The purpose of this study was to compare the surgical outcomes of two different cerebral protection methods(retrograde cerebral protection(RCP) and antegrade selective cerebral protection(ASCP)) in type A aortic dissection surgery. MethodsFrom February 1995 to January 2007, 102 consecutive patients underwent type A aortic dissection surgery using RCP or ASCP. There was 93 acute dissections and 9 chronic dissections. RCP was used in 79 patients(Group A) and ASCP in 23(Group B). These patients were studied retrospectively. The groups were similar in preoperative and operative characteristics, but Group B had more older patients(more than 70 years old)(39.1% vs. 11.4%), more total arch replacement(30.4% vs. 6.3%) and longer hypothermic circulatory arrest(HCA) time(50짹27 minutes vs. 37짹18 minutes). ResultsOperative mortality was 6.3%(5/79) in Group A and 4.3%(1/23) in Group B. The incidence of permanent neurologic deficits was 10.1%(8/79) in Group A and 4.3%(1/23) in Group B. The incidence of temporary neurologic deficits was 2.5%(2/79) in Group A and 13%(3/23) in Group B. There were no statistical differences between two groups in operative mortality, postoperative bleeding and neurologic deficits(permanent and temporary). ConclusionThe early outcomes of both cerebral protection methods were favorable, but ASCP endured longer HCA times and more extended arch surgeries. Cerebral protection methods could be selected on the expected duration of hypothermic circulatory arrest time and the extent of arch replacement.