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Background. The purpose of this study was to redefine indications of open descending and thoracoabdominal aortic aneurysm repair in the younger population.Methods. Between 1991 and 2017, 2012 patients undergoing descending and thoracoabdominal aortic aneurysm repair at our institution were divided into 2 groups for comparison: younger (<50 years; 276 [14%]) and older ( ‡50 years; 1736 [86%]). Patient demographics and perioperative outcomes were retrospectively reviewed.Results. Younger patients had significantly more heritable thoracic aortic disease (HTAD; 53% vs 9%, P < .001) and chronic dissections (64% vs 26%, P < .001) and fewer comorbidities. The younger cohort underwent more extent II repairs (28% vs 15%, P < .001). Operative mortality was significantly lower in younger patients (6% vs 17%, P < .001). Significant disabling complications (composite of operative mortality, paraplegia/paraparesis, stroke, and dialysis) were seen in 17% of the younger patients and in 40% of older patients 40% (P < .001). In multivariate analysis, extent of repair and chronic obstructive pulmonary disease were independent

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