This study compared the outcomes of primary and staged surgery for interrupted aortic arch (IAA) with biventricular circulation. A search of our surgical database identified 181 patients who underwent surgical repair of IAA with biventricular anatomy between 1982 and 2022. The patients were divided according to whether they underwent surgery in 1982-2001 or 2002-2022 and were categorized according to their anomalies into a simple group and a complex group. Repair was one-stage in 130 patients (71.8%) and two-stage in 51 (28.2%). There were six early deaths (3.3%) and nine (5.0%) late deaths. The 20-year actuarial survival rate was 91.7%. The 20-year survival rate was 94.7% in the simple group and 82.9% in the complex group (P=.007); the respective rates were 91.7% and 96.8% in 1982-2001 (P=.63) and 68.4% and 90.1% in 2002-2022 (P =.012). Multivariate analysis identified a complex anomaly and surgery performed in 1982-2001 to be risk factors for mortality. Aortic arch reintervention was required in 26 patients (balloon dilation, n=15; surgical, n=11). The 15-year freedom from reintervention rate improved from 67.8% in 1982-2001 to 89.8% in 2002-2022 (P=.041). Multivariate analysis identified type of surgical approach and emergent surgery to be risk factors for reintervention on the aortic arch. The results of IAA surgery have improved in recent years, especially for complex cases. Development of surgical techniques and individualized treatment strategies could reduce postoperative mortality and morbidity. However, follow-up for recurrence of aortic arch obstruction is necessary.