ObjectiveTo summarize clinical experience and surgical indications of open stented elephant trunk (sET) procedure for the treatment of complex acute Stanford type B aortic dissection (AD). MethodsFrom February 2009 to April 2013, 25 patients with complex acute Stanford type B AD underwent open sET procedure in Beijing Anzhen Hospital. There were 22 male and 3 female patients with their age of 46.92±9.12 years (range, 30 to 66 years). There were 16 patients with hypertension and 3 patients with preoperative acute renal failure. All the patients received sET implantation via an aortic arch incision under deep hypothermic circulatory arrest. Concomitant procedures included extra-anatomic bypass grafting in 11 patients, Bentall procedure in 1 patient, aortic valve replacement in 3 patients, and ascending aorta plasty in 3 patients. Computed tomography angiography (CTA) was performed before discharge and during follow-up for all the patients. ResultsOperation time was 4-7 (5.5±0.7) hours, cardiopulmonary bypass time was 93-206 (137.64±30.02) minutes, aortic cross-clamping time was 28-109 (57.96±21.05) minutes, and selective cerebral perfusion time was 15-76 (26.76±11.88) minutes. There was no in-hospital death. Postoperatively, there were 2 patients with pulmonary complications, 2 patients with type I endoleak, 1 patient with acute renal failure, 1 patient with temporary neurological disorder, 1 patient with sudden ventricular fibrillation, and 1 patient with delayed wound healing. Mean follow-up time was 6-54 (25.76±16.15) months, and 2 patients were lost during follow-up. The follow-up rate was 92%.There was no late death during follow-up. ConclusionsOpen sET procedure is a reliable and efficacious therapeutic strategy for patients with complex acute Stanford type B AD. Surgical indications include complex Stanford type B AD without enough landing zone, type B AD with ascending aortic disease, aortic root disease, valvular heart disease, coronary artery disease and congenital heart defects, and type B AD caused by genetic connective tissue disorder.