Background: Acute aorta dissection (AD) is a fatal emergency, however, studies addressing the clinical characteristics, management, and outcome of acute AD in young adult patients aged under 45 years in China are very few. Methods: A retrospective study including 490 patients with acute AD as the final diagnosis was conducted. Patients’ demographics, clinical characteristics, medical history, and laboratory and diagnostic imaging findings were retrieved from medical records. Results: The median age of young adult patients with acute AD was 38 years old with an interquartile range from 33 to 41. Male and smoker constituted 84.49% and 50.61% of the cohort, respectively. Hypertension was found in 54.49%, while Marfan syndrome was seen in 4.29% of the patients. Abrupt onset of chest or back pain was the most common symptoms (85.31%), while altered consciousness, coma and oliguria were less reported. Most patients (89.39%) were managed with surgical interventions. Typical complications (central nervous system complications, spinal cord ischemia, myocardial ischemia/infarction, mesenteric ischemia/infarction and acute renal failure) were seen in a small portion of treated patients during perioperative period. For in-hospital mortality there were 24 (∼5%) cases recorded. Correlation analysis indicated that perioperative complications were associated with the length of cardiopulmonary bypass (CPB) (P < 0.0001), and mortality after surgery correlated history of prior cardiac surgery (P = 0.043). Conclusion: CPB and prior cardiac surgery were associated with perioperative complications and mortality after surgery, respectively. The findings are valuable to the further refinement of diagnosis and surgical management of patients with acute aortic dissection. © 2019, © 2019 Taylor & Francis Group, LLC.