Has the Time Come for Regionalization of Surgery for Acute Type A Dissection?

The updated version of an expert viewpoint on resources for management of acute aortic syndrome in the United States is presented. The esteemed authors advance the position of positive volume–outcome relationship for surgery for acute De Bakey I and II (ATAAD). They provide a historical perspective in favor of specialization and they comment on data on transferring the victims of ATAAD to aortic centers. The primary outcome measure is that of operative mortality rather than stroke. The case made is also relevant to European and global trends, although the geography, telecommunication, transport and health systems vary considerably from country to country.