The Yasui operation for patients with adequate-sized ventricles and ventricular septal defect associated with obstructions of the aortic arch and left ventricular outflow tract

Nakano, Toshihide; Kado, Hideaki; Tatewaki, Hideki; Hinokiyama, Kazuhiro; Machida, Daisuke; Ebuoka, Noriyoshi; Yasui, Hirofumi

doi:10.1093/ejcts/ezt658

Cited by 39 publications

(26 citation statements)

References 22 publications

(49 reference statements)

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“…5,7,13 The Yasui operation can be performed either as a primary repair or as part of a staged strategy for patients with adequatesized ventricles with VSD associated with aortic arch obstruction and LVOTO. 14,15 Yasui et al reported their results with initial palliation with bPAB. Eight of the 11 patients had Yasui operation later successfully.…”

Section: Discussionmentioning

confidence: 99%

Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants

Erek

Suzan

Aydın

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV). Methods: Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration. Results: One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1. Conclusion: Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.

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Section: Discussionmentioning

confidence: 99%

Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants

Erek

Suzan

Aydın

et al. 2019

World J Pediatr Congenit Heart Surg

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“…All 4 deaths involved patients with genetic syndromes (DiGeorge syndrome, 3; trisomy 22, 1). Nakano et al [5] recorded 1 (5.9%) operative death in a group of 17 patients with adequate-sized ventricles and ventricular septal defects, associated with aortic arch obstruction or LVOTO, who underwent a Yasui operation. Carrillo et al [6] reported a 6.7% operative mortality rate in 18 patients undergoing a Yasui operation for critical aortic stenosis or atresia, hypoplastic aortic arch, and a well-developed left ventricle with a ventricular septal defect.…”

Section: Discussionmentioning

confidence: 99%

“…As Nakano et al [5] have noted, bilateral PA banding is useful as an initial palliative procedure in symptomatic neonates with LVOTs of marginal size, because it is less invasive than a Norwood procedure, and it allows surgeons to entertain either a Yasui operation or a standard biventricular repair, based on subsequent LVOT growth. A hybrid procedure incorporating bilateral PA banding and ductal stenting may be even more useful, because there is no need for continuous prostaglandin therapy after uneventful placing of stents, and the patient may be readily discharged.…”

Section: Discussionmentioning

confidence: 99%

Staged Repair after Hybrid Palliation for Interrupted Aortic Arch with Systemic Outflow Tract Obstruction

Lee

Kim

Lee

2019

Korean J Thorac Cardiovasc Surg

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Surgical management of interrupted aortic arch (IAA) with systemic outflow tract obstruction is clearly a challenge. If both ventricles are adequate, the Yasui operation is a useful option. Otherwise, a staged approach through initial hybrid palliation and delayed biventricular repair, tailored to the degree of obstructed outflow, serves to avoid a high-risk neonatal procedure. Herein, we present a patient with IAA and severe systemic outflow tract obstruction whose treatment involved hybrid palliation, followed by a Yasui operation.

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“…Severe LVOTO and complex, multilevel LVOTO may be best managed with LVOT bypass procedures such as a Norwood, Yasui (Norwood/Rastelli), or Ross-Konno procedure. [25][26][27][28][29] These procedures have been shown to decrease the rate of reoperation for LVOTO but due to the required placement of a right ventricle to pulmonary conduit, increase the rate of right heart reinterventions. 28…”

Section: Iaa-vsd With Lvotomentioning

confidence: 99%

Perioperative and Anesthetic Considerations in Interrupted Aortic Arch

Burbano-Vera

Zaleski

Latham

et al. 2018

Semin Cardiothorac Vasc Anesth

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Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta and is classified based on the anatomic level of interruption. IAA is associated with a number of intracardiac anomalies with the most common being patent ductus arteriosus, ventricular septal defect, and left ventricular outflow obstruction. There is also a strong association between type B interruption and 22q11 deletion syndrome. The perioperative management of the neonate with IAA begins in the intensive care unit with optimization of end-organ perfusion and function. Survival depends on the prompt initiation of prostaglandin E1 in order to maintain ductal patency, careful management of the patient's ratio of pulmonary to systemic blood flow (Qp:Qs), and a thorough understanding of the physiologic implications of the surgical plan, type of interruption, and associated syndromes and anomalies. This review will focus on the anatomy, physiology, and perioperative anesthetic management considerations specific to the management of IAA.

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The Yasui operation for patients with adequate-sized ventricles and ventricular septal defect associated with obstructions of the aortic arch and left ventricular outflow tract

Abstract: The results of the Yasui operation were excellent, showing low mortality and good mid-term left ventricular function without outflow tract stenosis or neoaortic valve insufficiency. Bilateral PAB as initial palliation is a useful option in symptomatic neonates.

Cited by 39 publications

References 22 publications

Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants

Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants

Staged Repair after Hybrid Palliation for Interrupted Aortic Arch with Systemic Outflow Tract Obstruction

Perioperative and Anesthetic Considerations in Interrupted Aortic Arch

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