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Surgical Reinterventions After Primary vs Staged Yasui Operation.

Maureen A McKiernan1, Mohan M John1, Joshua M Rosenblum1

  • 1Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.

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Summary
This summary is machine-generated.

The Yasui procedure offers good long-term survival for complex heart conditions. Both primary and staged approaches show similar survival, with a trend towards fewer reoperations for the staged method.

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Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Management
  • Cardiovascular Outcomes Research

Background:

  • The Yasui procedure is a complex surgical technique for congenital heart defects, combining elements of the Norwood and Rastelli operations.
  • It can be performed as a single-stage neonatal procedure or a staged approach.
  • Limited data exist on long-term survival and reintervention rates, necessitating further investigation.

Purpose of the Study:

  • To report the largest single-institution experience with the Yasui procedure.
  • To compare outcomes, specifically overall survival and freedom from reoperation, between primary and staged Yasui operations.
  • To evaluate the long-term efficacy and safety of the Yasui procedure.

Main Methods:

  • A retrospective review of patients who underwent the Yasui operation between 2001 and 2020.
  • Patients were categorized into two groups: primary Yasui (n=7) and staged Yasui (n=32).
  • Outcomes analyzed included overall survival and freedom from reoperation, with statistical comparisons between groups.

Main Results:

  • Overall survival for the entire cohort was 85.5% at 10 years, with no significant difference between primary and staged Yasui groups.
  • Primary Yasui involved longer cross-clamp times (116 vs 71.5 minutes), while staged Yasui utilized larger right ventricle to pulmonary artery conduits (14 mm vs 10 mm).
  • A trend towards longer freedom from right ventricular outflow tract (RVOT) reoperation was observed in the staged Yasui group (HR, 0.36; P = .06).

Conclusions:

  • The Yasui procedure demonstrates favorable long-term survival.
  • Patients face a lifelong risk of reintervention, particularly for the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT).
  • While survival and time to reoperation were similar between primary and staged approaches, staged Yasui showed a trend toward improved RVOT reoperation-free survival.