Outcome Following Open Repair of Hereditary and Non-Hereditary Thoracoabdominal Aortic Aneurysm in Patients Under 60 Years Old—A Multicenter Study

<b>Objective:</b> This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. <b>Methods:</b> We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000-2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan-Meier curve to assess survival, and logistic regression to identify predictors. <b>Results:</b> Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], <i>p</i> = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, <i>p</i> < 0.001) with lower BMI (24.1 vs. 28.4 kg/m², <i>p</i> < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), <i>p</i> < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), <i>p</i> < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), <i>p</i> < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], <i>p</i> < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), <i>p</i> < 0.001). Pulmonary complications (67.0% vs. 61.1%, <i>p</i> = 0.32), acute kidney injury (25.5% vs. 22.8%, <i>p</i> = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, <i>p</i> = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. <b>Conclusions:</b> Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status.