{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:11:15Z","timestamp":1775146275051,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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\u20132025). Patients were stratified by valve phenotype (tricuspid [TAV], n = 45; bicuspid [BAV], n = 19) and age (&lt;70 years, n = 52; \u226570 years, n = 12). Endpoints were early safety, long-term survival, and aortic redilatation (\u226550 mm). Results: Outcomes diverged markedly by subgroup. Patients aged \u226570 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 &lt;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 (\u226570 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.<\/jats:p>","DOI":"10.3390\/medicina62040672","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:14:43Z","timestamp":1775142883000},"page":"672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age-Dependent Outcomes of Reductive Ascending Aortoplasty"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7932-0733","authenticated-orcid":false,"given":"\u017divojin S.","family":"Jonjev","sequence":"first","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilija","family":"Bjeljac","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1294-4481","authenticated-orcid":false,"given":"An\u0111ela","family":"Bo\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2537-2172","authenticated-orcid":false,"given":"Mirko","family":"Todi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, 21102 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Jonjev","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Novi Sad, 21102 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9780-2533","authenticated-orcid":false,"given":"Aleksandar M.","family":"Milosavljevi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, 21102 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jovan","family":"Raji\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Strahinja","family":"Mrvi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, 21204 Sremska Kamenica, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.athoracsur.2016.06.005","article-title":"Early Prognosis of Reduction Ascending Aortoplasty in Patients with Aortic Valve Disease: A Single Center\u2019s Experience","volume":"103","author":"Liu","year":"2017","journal-title":"Ann. 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