Yasui procedure results: A multicenter retrospective study

Background: Aortic atresia or stenosis with ventricular septal defect (VSD) is a rare congenital heart defect. In 1987, Yasui introduced a biventricular repair for severe subaortic obstruction and subaortic VSD. Contemporary series report early mortality <15 %. Comparative inferences by surgical strategy remain limited by small samples, with the largest published series including 25 patients. Objectives: To evaluate the outcomes and complications following primary versus staged Yasui procedures. Methods: Retrospective multicenter study included 26 patients who underwent the Yasui procedure at 10 cardiac surgery centers in Russia, Belarus, and Kazakhstan (2008–2023). Results: There were no deaths in the primary Yasui group; 12-month survival in the staged Yasui group was 76.9 % (95 % CI: 54 %–88 %, p = 0.08). Freedom from reoperation at 92 months was 58.9 % (95 % CI: 23.5 %–82.4 %) in the primary Yasui group and 34.0 % (95 % CI: 9.1 %–61.6 %) in the staged group. Freedom from left ventricular outflow tract obstruction (LVOT) at 60 months was 76 % (95 % CI: 30.7 %–93.9 %) in the primary Yasui group and 57 % (95 % CI: 21.7 %–81.5 %) in the staged Yasui group. Conclusions: In this multicenter descriptive series, biventricular repair using the Yasui procedure was feasible and associated with low early mortality in selected patients with hypoplastic left heart syndrome (HLHS) and associated VSD. Within the limits of this small retrospective cohort, surgical strategy (primary vs staged Yasui) did not appear to affect mortality, reoperation, or the incidence of LVOT obstruction.