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<i>Background and Objectives</i>: The aim of this study was to analyze the influence of mass transfusion on the postoperative outcome and survival in patients presenting with acute Type A aortic dissection. <i>Materials and Methods</i>: Between 2002 and 2020, a total of 505 patients were surgically treated for an acute Type A aortic dissection. Mass transfusion was defined as the peri- and postoperative replacement by transfusion of 10 units. Patient characteristics and outcomes were analyzed and compared between patients with and without mass transfusion. <i>Results</i>: Mass transfusion occurred in 105 patients (20%). The incidences of symptomatic coronary malperfusion (<i>p</i> = 0.017) and tamponade (<i>p</i> = 0.043) were higher in patients with mass transfusion. There was no statistically significant difference in the distal extension of the aortic dissection between the two groups. A valved conduit was significantly more common in patients with mass transfusion (<i>p</i> = 0.007), while the distal aortic repair was similar between the two groups. Cardiopulmonary bypass time (<i>p</i> < 0.001), cross clamp time (<i>p</i> < 0.001) and in-hospital mortality were significantly higher in patients with mass transfusion (<i>p</i> < 0.001), but the survival after discharge (landmark-analysis) showed equal survival between patients with and without mass transfusion (log rank: <i>p</i> = 0.4). Mass transfusion was predictive of in-hospital mortality (OR: 3.308, <i>p</i> < 0.001) but not for survival after discharge (OR: 1.205, <i>p</i> = 0.661). <i>Conclusions</i>: Mass transfusion is necessary in many patients with acute Type A aortic dissection. These patients present sicker and require longer surgery. However, mass transfusion does not influence survival after discharge.