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Background We sought to investigate the best degree of hypothermic cardiac arrest (HCA) in type A aortic dissection (TAAD) with a cohort of 1,018 cases receiving total arch replacement from 2013 to 2018 in Fuwai Hospital. Method The cohort was divided by DHCA (≤24°C, n = 58 vs. MHCA (24°C, n = 438), and interquartile range (Q1-Q4). Primary endpoints included mortality, stroke, paraplegia, and continuous renal replacement therapy (CRRT), which were summarized as composite major outcomes (CMO). Results The Odds Ratio (OR) of CMO for