Type A aortic dissection (TAAD) can occur in heart transplant (HTx) recipients and lead to a potentially fatal catastrophe. It is understudied outside of case reports and outcomes are unclear. In this study, we aimed to describe the patient characteristics and clinical outcomes of TAAD in HTx recipients using a national United States database. The National Inpatient Sample (NIS), a United States all-payer inpatient database, was queried to identify all hospitalizations of TAAD in HTx recipients ≥18 years from 2002 to 2018. ICD-9 and ICD-10 diagnosis and procedure were used to obtain the target patient population. Primary outcomes were in-hospital mortality, length of stay, and post-operative complications. Weighted values of hospitalizations were used to generate population-level estimates. From 625,643,571 total hospitalizations, we identified 78 TAAD in HTx recipients. The number of cases for TAAD in HTx recipients per year has largely remained stable. Compared to 70,715 TAAD patients without a history of organ transplantation, TAAD in HTx recipients were younger (55.3 vs 60.7 years), less likely female (18.5% vs 33.5%), more likely Black or Hispanic (55.1% vs 22.9%), and treated exclusively at urban teaching hospitals. TAAD in HTx recipients were more likely to have Marfan syndrome (12.9% vs 2.6%), congestive heart failure (45.9% vs 19.4%), and chronic kidney disease (19.1% vs 10.4%. TAAD in HTx recipients had a higher in-hospital mortality (30.1% vs 17.8%) and a longer length of stay (29.5 vs 13.7 days). They also had higher rates of post-operative cardiac (56.5% vs 30.7%), respiratory (70.3% vs 41.1%), renal (76.1% vs 29.7%), and bleeding complications (37.1% vs 13.5%). The occurrence of TAAD in HTx recipients is rare but confers an increased in-hospital mortality, length of stay, and risk for post-operative complications. The characteristics of TAAD in HTx recipients appear to be distinct from the general TAAD patient population. HTx recipients with risk factors that may predispose them to TAAD should receive additional attention to prevent this lethal condition. [ABSTRACT FROM AUTHOR]