Background: Females usually have a higher risk in cardiac surgery than males. Type A acute aortic dissection can occur in both males and females, but there are not enough studies about gender difference in clinical features and surgical outcome. Objective: This study aimed to evaluate the clinical data and surgical outcome difference between males and females with type A acute aortic dissection. Patients and Methods: This was a comparative retrospective study that took place between January 2014 and May 2021, in 7 centres in Egypt and Saudi Arabia. We had 427 patients presented to us and were operated for type A acute ascending aortic dissection, of them 291 (68.15%) were males and 136 (31.85%) were females where group 1 consisted of males, while group 2 included the female patients. We compared their clinical features, in hospital course and outcome and follow up in the first six-month post-surgery. Results: There was no statistically significant difference between both groups regarding operative data. There were statistically significant longer duration of mechanical ventilation > 48 h (27.94% vs 6.19%, P < 0.001), intensive care unit (ICU) was 8.1 ± 4.2 vs 2.7 ± 1.15 (P < 0.001), hospital stay was 17.2 ± 8.1% vs 12.6 ± 4.8 (P < 0.001) and reoperation for bleeding was 7.35% vs 1.37% (P < 0.001) in females more than males. Also hospital mortality was statistically significant higher in females than in males (5.88% vs 1.03%, P < 0.001). Regarding other post-operative morbidities and six months follow up, there were no statistically significant difference between both groups. Conclusions: Type A aortic dissection occurred more frequently in males than females. Females presented to us were older, had more comorbidities and mortality than males and the surgical outcomes was better in males than in females.