Reductive ascending aortoplasty achieved 83.3% 10-year freedom from redilatation in patients ≥70 years, whereas bicuspid valve patients experienced higher redilatation rates of 31.6%.
Does reductive ascending aortoplasty (RAA) during AVR prevent aortic redilatation and provide safe long-term outcomes in patients with dilated ascending aorta?
Reductive ascending aortoplasty during AVR is a durable, tissue-preserving option for older patients (≥70 years) with tricuspid aortic valves, but should be avoided in those with bicuspid valves due to high redilatation rates.
Absolute Event Rate: 0% vs 0%
Background and Objectives: The optimal management of dilated ascending aorta during aortic valve replacement (AVR) in older or high-risk patients remains debated. While graft replacement is the standard procedure, reductive ascending aortoplasty (RAA) may offer a less invasive, tissue-preserving alternative. This study evaluated long-term RAA outcomes and identified the optimal patient profile. Materials and Methods: In a single-center cohort, 64 patients underwent AVR with unwrapped RAA (2005–2025). Patients were stratified by valve phenotype (tricuspid TAV, n = 45; bicuspid BAV, n = 19) and age (<70 years, n = 52; ≥70 years, n = 12). Endpoints were early safety, long-term survival, and aortic redilatation (≥50 mm). Results: Outcomes diverged markedly by subgroup. Patients aged ≥70 years demonstrated excellent 10-year freedom from redilatation (83.3%) with no reinterventions. In contrast, BAV patients had higher redilatation rates (31.6% vs. 8.9%; p = 0.053) and a trend toward more reexploration for bleeding (15.8% vs. 6.7%; p = 0.109). Redilatation and reintervention were concentrated in patients <70 years. Conclusions: RAA with AVR offers favorable long-term durability, but success is highly age-dependent. The procedure is a safe, effective tissue-preserving strategy for selected older patients (≥70 years), particularly those with TAV. However, high redilatation rates in BAV patients suggest that RAA should be avoided in this population, reinforcing graft replacement as preferred for younger patients.
Jonjev et al. (Wed,) reported a other. Reductive ascending aortoplasty achieved 83.3% 10-year freedom from redilatation in patients ≥70 years, whereas bicuspid valve patients experienced higher redilatation rates of 31.6%.
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