Aim: This retrospective study aimed to explore mortalitypredictors in patients undergoing surgical repair forAcute Stanford Type A Aortic Dissection (ATAAD) withconcomitant pericardial hematoma between 2010 and2022.Material and Method: Data from 270 patients werereviewed, focusing on 42 cases with preoperativepericardial hematoma while excluding Type B dissections,chronic cases, and redos. Pericardial hematomaconfirmation employed preoperative imaging andsurgical evidence. Hemodynamic instability, defined bysystolic blood pressure <80 mmHg, was assessed.Results: Hemodynamic instability was observed in 25(59.5%) patients, and in-hospital mortality stood at35.7%. Multivariate analysis indicated hemodynamicinstability’s significant predictive role for mortality(p=0.004). While age, preoperative renal status, andprevious coronary intervention lacked direct associationswith early mortality, hemodynamic instability emergedas a strong determinant.Conclusion: This study underscores the paramountsignificance of hemodynamic instability in determiningmortality outcomes in patients with pericardialhematoma and ATAAD undergoing surgical repair.