Surgical Reinterventions After Primary vs Staged Yasui Operation

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.