<p>To summarize the surgical treatment experience and long-term outcomes of patients with anomalous origin of one pulmonary artery from the ascending aorta (AOPA). From December 2009 to December 2022, 76 patients undergoing surgical treatment for AOPA in our hospital were enrolled. Two different reimplantation methods were used to correct the anomaly, including direct anastomosis in 45 (group A) and angioplasty with autologous tissue in 31 patients (group B). Early and late outcomes were compared between the two groups, and the independent risk factors for aberrant pulmonary artery(aPA) restenosis were determined. The median age at repair was 90 (8–1211) days. Hospital death occurred in two patients. During the follow-up period, there was no all-cause death. One patient in group A was lost to follow-up. Freedom from postoperative aPA restenosis at 1, 5, and 10 years in A group was 92.3, 85.4, and 85.4%, respectively. Freedom from postoperative aPA restenosis at 1, 5, and 10 years in B group was 75.2, 63.3, and 57.5%, respectively (log-rank, <i>P</i> = 0.038). Multivariate Cox proportional hazards regression analysis showed that smaller innate Z-score of aPA and angioplasty with autologous tissue were independent risk factors for aPA restenosis. Freedom from reintervention for aPA restenosis at 1, 5, and 10 years in A group was 97.1, 93.0, and 93.0%, respectively. Freedom from reintervention for aPA restenosis at 1, 5, and 10 years in B group was 95.7, 85.3, and 77.5%, respectively (log-rank, <i>P</i> = 0.235). Surgical reimplantation in AOPA patients has resulted in favorable long-term outcomes. Direct anastomosis is superior to angioplasty with autologous tissue in avoiding late aPA restenosis. Intrinsic dysplasia of aPA also increases the incidence of stenosis. However, the type of reimplantation did not significantly affect late reintervention.</p>