Building paths to healthcare: an explorative qualitative study among undocumented mothers experiencing maternal and infant healthcare access in Switzerland.

Acute type A aortic dissection (ATAAD) represents a life-threatening diagnosis that carries a high risk of mortality (). Advanced age is a well-known independent risk factor for increased mortality in ATAAD. According to European registry data (GERAADA), septuagenarians (70–79 years of age) show a perioperative mortality of around 16%, whereas octogenarians (80–89 years of age) show substantially higher early in-hospital mortality of about 30% (). In addition to age, other factors such as center volume and surgical expertise, presence of malperfusion, the extent of repair and patient morbidity are major modifiers (). Elderly patients have several additional vulnerabilities compared to younger patients such as impaired renal function, higher incidence of malperfusion, frailty, poor tissue quality and further comorbidities which contribute to their increased susceptibility in case of prolonged cardiopulmonary bypass (CPB), hypothermic circulatory arrest (HCA) and overall long operative times (). With the general increase in human life expectancy and improved healthcare, an increasing number of elderly patients are being referred for aortic surgery. Defining clear clinical outcomes in this cohort may provide further insight into potential risk factors and outcome patterns relative to younger patients. These findings may inform ongoing discussions about the use of open surgery in elderly patients under varying clinical circumstances ().