Surgical Reinterventions After Primary vs Staged Yasui Operation

The Yasui procedure combines the elements of the Norwood and Rastelli operations. It can be performed in a single stage during the neonatal period or as a staged procedure. Long-term survival and reintervention data are limited. We present the largest single-institution report on outcomes after the Yasui procedure.

A retrospective review was performed of patients who underwent the Yasui operation at our institution from 2001 to 2020. Patients were divided into 2 groups, primary and staged Yasui. The outcomes of interest were overall survival and freedom from reoperation.

Primary Yasui was performed in 7 patients and staged Yasui in 32 patients. There was no difference in baseline characteristics between the groups. Primary Yasui patients had longer cross-clamp times (116 vs 71.5 minutes; P = .004), whereas staged Yasui patients had significantly larger right ventricle to pulmonary artery conduits placed at completion of biventricular repair (14 mm vs 10 mm; P < .001). Overall survival for the cohort was 85.5% at 10 years, with no significant difference between the groups. There was a trend toward longer freedom from right ventricular outflow tract (RVOT) reoperation for the staged Yasui (hazard ratio, 0.36; 95% CI, 0.12-1.07; P = .06).

The Yasui procedure is associated with good long-term survival and a lifelong risk of RVOT and, to a lesser extent, left ventricular outflow tract reinterventions. There was no significant difference in survival or time to reoperation between primary and staged Yasui. There was, however, a trend toward longer freedom from RVOT reoperation with staged Yasui.