The Aorta Is One Organ; Our Response Is Not: A Global Case for Systems Redesign in Acute Aortic Syndromes

The aorta is a single arterial organ, yet the clinical response to its diseases is fragmented across specialties, institutions, and nations. Acute aortic syndromes remain lethal at every stage of the care continuum: a large share of patients with type A dissection die before reaching any hospital, roughly half die before reaching a specialist centre, a substantial proportion are misdiagnosed at first medical contact, and untreated mortality has historically been estimated at approximately one to two percent per hour. Reported 30-day mortality differs across surgical registry cohorts-for example, 7.6% in the Japan Cardiovascular Surgery Database and 16.9% in the cited GERAADA cohort-but such ecological comparisons are descriptive and cannot identify the contribution of organisational, biological, clinical, or ascertainment differences. This review synthesises registry, population, and health-services data from Europe, Japan, North America, and low- and middle-income settings to characterise where the pathway fails and what each system has already demonstrated. We argue that the next material advance in aortic care will come not from any single innovation in isolation but from the architecture that connects prevention, diagnosis, treatment, and follow-up and that system redesign and technological progress are complementary rather than competing; we propose a five-pillar framework (Prevention, Presentation, Pathway, Person, and Learning) mapped throughout to published exemplars and future research priorities.