This study analyzed the incidence of malperfusion in acute Type A aortic dissection using data from 9,958 patients in the Society of Thoracic Surgeons Adult Cardiac Surgery Database 2017-2020. Preoperative malperfusion occurred in 27.7 percent of cases and was linked to significantly higher operative morality, particularly for contrary and mesenteric malperfusion. The findings indicated that partial arch replacement did not increase mortality compared to ascending aorta or hemiarch replacement alone, regardless of malperfusion status.