The Yasui procedure is a pediatric heart operation used to bypass the
left ventricular outflow tract
A ventricular outflow tract is a portion of either the left ventricle or right ventricle of the heart through which blood passes in order to enter the great arteries.
The right ventricular outflow tract (RVOT) is an infundibular extension of the ...
(LVOT) that combines the aortic repair of the
Norwood procedure
The Norwood procedure is the first of three surgeries intended to create a new functional systemic circuit in patients with hypoplastic left heart syndrome and other complex heart defects with single ventricle physiology. The first successful Norw ...
and a shunt similar to that used in the
Rastelli procedure
The Rastelli procedure is an open heart surgery, open heart surgical procedure developed by Italian people, Italian physician and human heart, cardiac surgery researcher, Giancarlo Rastelli, in 1967 at the Mayo Clinic, and involves using a pulmo ...
in a single operation.
It is used to repair defects that result in the physiology of
hypoplastic left heart syndrome
Hypoplastic left heart syndrome (HLHS) is a rare congenital heart defect in which the left side of the heart is severely underdeveloped and incapable of supporting the systemic circulation. It is estimated to account for 2-3% of all congenital hea ...
even though both ventricles are functioning normally. These defects are common in
DiGeorge syndrome and include
interrupted aortic arch
In digital computers, an interrupt (sometimes referred to as a trap) is a request for the processor to ''interrupt'' currently executing code (when permitted), so that the event can be processed in a timely manner. If the request is accepted, ...
and
LVOT obstruction (IAA/LVOTO);
aortic atresia-
severe stenosis with
ventricular septal defect (AA/VSD); and aortic atresia with interrupted aortic arch and
aortopulmonary window. This procedure allows the surgeon to keep the
left ventricle connected to the
systemic circulation
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
while using the
pulmonary valve as its outflow valve, by connecting them through the ventricular septal defect. The Yasui procedure includes a modified
Damus–Kaye–Stansel procedure
The Damus–Kaye–Stansel (DKS) procedure is a cardiovascular surgical procedure used as part of the repair of some congenital heart defects. This procedure joins the pulmonary artery and the aorta in situations where the systemic circulation is ...
to connect the
aortic
The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ox ...
and
pulmonary roots, allowing the
coronary arteries to remain perfused.
It was first described in 1987.
Indications
A Yasui procedure can be done instead of a
Norwood operation in some cases of LVOT obstruction to avoid committing a child to a single-ventricle heart, or it can follow a Norwood operation when the surgeon uses a staged approach. It is also used when the
Ross procedure or
Konno procedure
Konno (written: 金野, 今野 or 紺野) is a Japanese surname. Notable people with the surname include:
*, Japanese footballer
*, Japanese ski jumper
*, Japanese idol and singer
*, Japanese politician
*Ford Konno (born 1933), American swimmer
*, ...
are not feasible in children who have had other surgeries to repair
coarctation of the aorta
Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word ''coarctation' ...
or interrupted aortic arch.
Technique
The Yasui procedure is done via a
median sternotomy and uses
cardiopulmonary bypass. If there is a
patent ductus arteriosus, the surgeon begins by closing it. The surgeon then connects the separated parts of the aorta together. The surgeon then transects the
pulmonary artery and
aorta and frees them from surrounding tissue, then makes an incision into the
right ventricle to allow them to assess the ventricular septal defect and remove excess muscle bundles in cases of extensive
right ventricular hypertrophy. If the ventricular septal defect is smaller than the pulmonary valve, the surgeon will enlarge the defect. The surgeon then uses a patch, commonly made of bovine (cow)
pericardium or the child's own tissue, to create a tunnel between the ventricular septal defect and the pulmonary valve. This allows for blood to flow from the left ventricle to the pulmonary valve. After creating this tunnel, the surgeon connects the aortic and pulmonary roots (Damus-Kaye-Stansel anastomosis).
Outcomes
Children typically have good cardiac function and survival after the Yasui procedure, similar to other operations for the same conditions. However, children may require re-operation to replace the conduit in their heart if they outgrow it. Long-term survival depends on other factors, such as genetic disease.
[{{Cite journal, last=Takabayashi, first=Shin, last2=Kado, first2=Hideaki, last3=Shiokawa, first3=Yuichi, last4=Fukae, first4=Kouji, last5=Nakano, first5=Toshihide, date=September 2005, title=Long-term outcome of left ventricular outflow tract after biventricular repair using Damus-Kaye-Stansel anastomosis for interrupted aortic arch and severe aortic stenosis, journal=The Journal of Thoracic and Cardiovascular Surgery, volume=130, issue=3, pages=942–944, doi=10.1016/j.jtcvs.2005.05.030, issn=0022-5223, pmid=16153978, doi-access=free]
References
Cardiac surgery
Surgical procedures and techniques