Impact of a healthcare network “Aorta Code” on outcomes of elderly patients with type A acute aortic syndrome

BACKGROUND AND OBJECTIVES Type A-acute aortic syndrome (AAS-A) is associated with a high morbidity and mortality. The management of elderly patients with AAS-A is challenging. The aim of this study was to evaluate the current prognosis of elderly patients with AAS-A, and to analyze the impact of surgery on a healthcare network. METHODS Patients with AAS-A were prospectively and consecutively collected from 2019 to 2024 in a four-hospital network "Aorta Code" with a tertiary care referral centre for cardiac surgery. Patients were classified according to age into two groups: ≥75-year-old and under 75-year-old. Clinical, diagnostic, treatment and prognostic variables were analyzed. Primary outcomes included 30-day mortality, time from symptoms to diagnosis and time from diagnosis to surgery. RESULTS A total of 102 patients were included. Of these, 36 were ≥75-year-old. Most patients (90%) had classical aortic dissection. The length of the aortic injury was shorter in the elder group. Older patients had more comorbidities, most were frail and mildly dependent, and took longer to be diagnosed. Complications at the time of diagnosis and time from diagnosis to surgery were similar in both groups. Preoperative mortality risk was higher in elderly patients and surgery was less extensive on them. Surgery was associated with a mortality reduction in both groups. CONCLUSIONS Elderly patients with AAS-A have more comorbidities, are diagnosed later and have higher mortality than younger patients. Yet, in a dedicated healthcare network, surgery is associated with a reduction in mortality even in the older population.