OBJECTIVES: Our goal was to compare the performance of the frozen elephant trunk (FET) and the hybrid aortic arch debranching procedures for acute Type I aortic dissection. METHODS: From January 2013 to December 2015, 168 patients with Type I aortic disease underwent ascending aorta and total aortic arch replacement with FET implantation (the FET group, n = 132) or arch debranching with 1-stage aortic arch exclusion using an endovascular stent in a retrograde manner (the debranching group, n = 36). A propensity score-matched subgroup of 26 pairs was identified. Perioperative data and mid-term follow-up results were assessed. RESULTS: In the FET and the debranching groups, the 30-day mortality rates were 14.4% and 5.6% (P = 0.254) and the incidence of stroke was 5.3% and 5.6% (P > 0.999). Cardiopulmonary bypass time was significantly shortened, and the circulatory arrest was exempted in the debranching group. Cardiopulmonary bypass time was identified as a predictor for 30-day mortality (P = 0.027, odds ratio 1.01). Body mass index >= 25 kg/m(2) was associated with multiorgan dysfunction syndrome (P = 0.016, odds ratio 3.51). Surgical modality did not significantly affect early outcomes. The 3-year survival rate was 76.1% (95% confidence interval, 63.0-81.9%) in the FET group and 82.5% (95% confidence interval, 65.2-91.8%) in the debranching group (P = 0.330). CONCLUSIONS: The hybrid aortic arch procedure without circulatory arrest can be safely performed on patients with acute Type I aortic dissection. Irrespective of cost-effectiveness, arch debranching was a promising alternative for patients who were unfit for the FET procedure.