The surgical results observed in 80 patients with aneurysms of the aortic arch who underwent an operation between January 1986 and the end of August 1992 were analyzed by multivariate analysis to identify predictors of high operative risk. All operations were performed using a cardiopulmonary bypass technique, blood cardioplegia for myocardial protection, and selective cerebral perfusion to prevent cerebral ischemia during aortic arch repair. The overall early (30-day) mortality rate was 16.3%. A severe stroke occurred postoperatively in 1 patient (1.3%). The 5-year survival rate was 73% +/- 5%, as determined by the Kaplan-Meier method. Multivariate analysis revealed that the presence of critical cardiopulmonary dysfunction preoperatively and the need for reoperation were significant independent predictors. Of the 63 (79%) patients who were free of these risks, only 3 (4.8%) died. The findings from the present study indicate that, currently, early mortality is relatively low for all patients who undergo operations for aneurysm of the aortic arch, unless they are in a critical condition preoperatively or unless they are undergoing a reoperation.