Background Hybrid aortic arch reconstruction represents a treatment option for patients unsuitable for conventional open cardiovascular surgery. We analyzed patient outcome after hemiarch repair in zone 1 and zone 2 with regard to early and long-term results. Methods Between December 2004 and December 2012, a total of 47 patients underwent hemiarch repair for distal aortic arch disease. Supra-aortic debranching was performed in 23 patients for zone 1 (carotid-carotid crossover bypass) and in 24 patients for zone 2 (carotid-subclavian bypass/subclavian transposition) followed by thoracic endovascular aortic repair. All patients included had been refused for open surgery or were emergency cases. Results Mean age of the patients was 65.3 years; 51% of patients were symptomatic or presented with a contained aortic rupture. Overall technical success rate was 81%, with a 30-day mortality rate of 12.8%. A primary type Ia endoleak was observed in 19%. The mean follow-up period was 50.5 months (range, 1-93 months). Follow-up mortality was 14.9%; secondary endoleak rate was 8.5% for both groups. There was a trend of reduced primary type Ia endoleak rate for zone 2 repair compared with zone 1 (4.3% vs 14.9%; P =.07). Follow-up mortality was also improved for zone 2 repair (4.3% vs 10.6%; P =.41). Overall survival rate was 70%. Conclusions Hemiarch hybrid repair in high-risk patients is associated with an acceptable perioperative mortality risk and long-term survival. Zone 2 represents a feasible and effective treatment option for hybrid arch repair. Zone 1 is related with relevant risk for type Ia endoleak and higher mortality during follow-up. Lifelong surveillance after hybrid repair is essential.