Objective: The number of elderly patients undergoing emergency surgery for acute aortic dissection type A (AADA) is rising. Published results report a higher risk for these patients compared with younger patients. The aim of our study was to analyse the surgical outcome of these patients and to identify those at risk. Methods: Between July 2006 and June 2009, 44 centres participating in the German Registry for Acute Aortic Dissection Type A (GERAADA) reported a total of 1558 patients. As many as 381 patients were between 70 and 80 years of age (septuagenarians), while 83 patients were 80 years and older (octogenarians). We compared the clinical features and events occurring 30 days after surgery. Results: On admission, 23% (n= 89) of septuagenarians had cardiac tamponade, compared with 31% (n= 26) of those age ≥80 years (p= 0.13). A little more than 13% (n= 48) of septuagenarians were intubated at admission compared with 21% (n= 17) of octogenarians (p= 0.06). The septuagenarians' 30-day postoperative mortality was 16% (n= 60), whereas that of patients aged over 80 years was 35% (n= 29) (p< 0.001). The mean hospital stay in the younger group was 18 days, of which 12 days were in the intensive care unit, compared with 18 and 13 days for octogenarians, respectively. Conclusions: Emergency surgery for septuagenarians with acute aortic dissection type A (AADA) resulted in acceptable mortality. Octogenarians revealed significantly higher 30-day mortality (odds ratio (OR). = 3.23, confidence interval (CI). = (1.81-5.72)), although it was lower than the mortality among patients without surgical treatment. A surgical approach should be considered in all patients on an individual basis.