Patients with acute aortic syndrome (AAS) often require emergent transfer for definitive therapy. The aim of this study was to evaluate the safety of transfer and the ability to optimize hemodynamics in subjects with AAS transported by an aortic network. A total of 263 consecutive patients with suspected AAS transferred to a coronary care unit from March 2010 to June 2012 were included. Transfers were accomplished by the institutional critical care transfer system using ground ambulance (n = 47), helicopter (n = 196), or fixed-wing jet (n = 20) from referring centers directly to the coronary care unit, bypassing the emergency department. The transfer mortality rate was 0%, and the in-hospital mortality rate was 9% (n = 23). Initial systolic blood pressure and heart rate at the time of arrival of the transfer team to the referring hospital were compared with those on arrival to the coronary care unit. The median transfer distance was 66 km (interquartile range 24 to 119), and the median transfer time was 87 minutes (interquartile range 67 to 114). The transfer team achieved significant reductions in systolic blood pressure (from 142 ± 29 to 132 ± 23 mm Hg) (mean difference in systolic blood pressure 10 mm Hg, 95% confidence interval 7 to 14, p <0.0001) and heart rate (from 78 ± 16 to 75 ± 16 beats/min) (mean difference in heart rate 3 beats/min, 95% confidence interval 1 to 4, p <0.0001). In conclusion, these results indicate that patients with AAS can be safely transferred to specialized centers for definitive treatment, and a well-trained critical care transfer team can actively continue to optimize medical management during transit.