Purpose: External aortic support (EARS) and Personalised External Aortic Root Support (PEARS) are surgical options for ascending aortic and root replacement in aortopathy of various aetiologies. In view of the limited evidence, we aimed to evaluate the short and long-term outcomes between the two procedures. Methods: Between 2014 and 2021, 51 consecutive patients underwent aortic surgery at Waikato Hospital: 22 with PEARS and 29 with EARS. We conducted a retrospective analysis assessing short and long-term outcomes. All analyses were conducted using R software. Results: Preoperative characteristics were similar except for age: EARS: median 67y (IQR 58-74) vs PEARS: median 55y (IQR 37-70); (p=0.025). EARS was mainly associated with aortic valve replacement, while PEARS was associated with procedures involving a competent aortic valve. Intraoperative conversion was 1 (3.5%) for EARS and 2 (9.1%) for PEARS (p=0.42). There was no difference between groups in early mortality: 2 (6.9%) vs 0; (p=0.5), CVA: 1 (3.4%) vs 0; (p >0.9), AKI: 1 (3.4%) vs 0; (p >0.9) and in-hospital length of stay: EARS: median 9 days (IQR 6-15) vs PEARS: median 8 days (IQR 6-12); (p=0.2). Short-term follow-up (< 2 years) showed significant postoperative aortic diameter reductions in both: PEARS: Echo pre-op-median aortic diameter (AD): 5.05cm, (IQR 4.78-5.50); post-op-median AD: 4.35cm, (IQR 4.13-4.78); (p=0.004); CT pre-op-median AD: 5.20cm, (IQR 4.90-5.30); post-op-median AD: 4.75cm, (IQR 4.40-5.05); (p=0.04). EARS: ECHO pre-op-median AD 4.60cm, (IQR 4.15-4.80); post-op-median AD 4.20cm, (IQR 3.80-4.50); (p=0.005); CT pre-op-median AD 4.75cm, (IQR 4.60-4.88); post-op-median AD 4.15cm, (IQR 3.85-4.53); (p=0.015). Long-term survival with median FU time 7.35 years (CI:6.58-8.25) was not different between the groups (p=0.6). Conclusion In these retrospective single-centre analyses, we found no difference in short and long-term outcomes between PEARS and EARS