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Surgical Reinterventions After Primary Versus Staged Yasui Operation
Maureen A. McKiernan, MD, Mohan M. John, MD, Joshua M. Rosenblum, MD, PhD, Pranay Nayi, MPH, Fawwaz R. Shaw, MD, Subhadra Shashidharan, MD, Paul J. Chai.
Children's Healthcare of Atlanta/ Emory University, Atlanta, GA, USA.
Objectives: The Yasui procedure combines elements of the Norwood and Rastelli operations. It may be performed in a single stage during the neonatal period, or as a staged procedure. Long-term survival and reintervention data is limited in published literature. We present the largest single-center report on outcomes following the Yasui procedure. Methods: A retrospective review was performed of 37 patients who underwent the Yasui operation at our institution from 2001-2020. Patients were divided into two groups - Primary (PY) Yasui and Staged Yasui (SY). The outcomes of interest were overall survival and freedom from surgical reintervention. Results: PY was performed 8 patients, and SY in 29 patients. There was no difference in clinical characteristics between groups. In the SY group, median time to completion of biventricular repair was 271 days. Median right ventricle to pulmonary artery conduit size was significantly larger in the SY group (14 vs. 10 mm, p<0.0001). At 10 years, the overall survival was 84.5%, freedom from right ventricular outflow tract (RVOT) reoperation was 15.5%, and freedom from left ventricular outflow tract reoperation was 84.6% for the entire cohort. When comparing PY and SY, there was no difference in survival and rates of reintervention (p>0.05). Conclusions: Long-term survival following the Yasui procedure is encouraging. Most patients require surgical reintervention on the RVOT within 10 years. PY and SY have comparable long-term outcomes.
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