Age-Dependent Outcomes of Reductive Ascending Aortoplasty

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.