What is the Yasui procedure?

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Last updated: March 13, 2026 • View editorial policy

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What is the Yasui Procedure?

The Yasui procedure is a complex cardiac operation that combines elements of the Norwood and Rastelli operations to achieve biventricular repair in patients with two adequate-sized ventricles, a ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO) associated with aortic arch anomalies (such as interrupted aortic arch or aortic atresia). 1, 2, 3

Surgical Technique and Components

The Yasui operation consists of two main surgical components that work together to establish functional biventricular circulation 3, 4:

  • Norwood-type aortic arch reconstruction: The aortic arch is reconstructed to relieve obstruction and establish adequate systemic outflow 1, 3

  • Modified Rastelli component: An intraventricular baffle directs oxygenated blood from the left ventricle through the VSD to the pulmonary valve (which becomes the neo-aortic valve), while a right ventricle-to-pulmonary artery (RV-PA) conduit provides pulmonary blood flow 2, 3

  • Key anatomic result: The left ventricle functions as the systemic ventricle, but uses the pulmonary valve as the systemic semilunar valve rather than the obstructed native aortic valve 4

Specific Indications

The procedure is specifically designed for patients with 2, 5, 3:

  • Interrupted aortic arch (IAA) with LVOTO (most common indication) 2, 3
  • Aortic atresia or severe aortic stenosis with VSD 1, 2, 3
  • Coarctation of the aorta with severe LVOTO and VSD 5
  • Two adequate-sized ventricles (critical requirement distinguishing this from single-ventricle palliation) 2, 3

Surgical Timing: Primary vs. Staged Approach

The Yasui procedure can be performed using two different timing strategies 1, 3:

Primary (Single-Stage) Yasui

  • Performed during the neonatal period (typically within the first weeks of life) 1, 3
  • Longer cross-clamp times (median 116 minutes) but completes repair in one operation 1
  • Smaller RV-PA conduits typically placed (median 10 mm) 1

Staged Yasui

  • Initial Norwood procedure performed in the neonatal period for arch reconstruction and stabilization 3
  • Completion Yasui operation performed months later (median 6.9 months, range 4.3-26.6 months) when the infant is larger 3
  • Larger RV-PA conduits can be placed at completion (median 14 mm) 1
  • Trend toward longer freedom from RVOT reoperation compared to primary approach (hazard ratio 0.36, though not statistically significant) 1

Clinical Outcomes

Survival

  • Excellent overall survival: 85.5% at 10 years across combined cohorts 1
  • Early mortality is low: Zero early mortality in recent series, with 92-100% survival at 1 year 2, 3
  • No significant survival difference between primary and staged approaches 1, 3

Reintervention Requirements

Right ventricular outflow tract (RVOT) reintervention is nearly inevitable 1, 2, 5:

  • Conduit replacement/intervention required in 40-48% of patients during follow-up (median 5 years) 2, 5
  • Freedom from RVOT reoperation: 48% at median 5-year follow-up 2
  • Actuarial freedom from reoperation or death: 14% at 5 years after biventricular repair 3

Left ventricular outflow tract obstruction (LVOTO) reintervention is less common 2:

  • Freedom from LVOTO reoperation: 91% at late follow-up 2
  • Only 2 patients required baffle revision at 6 and 9 years in one series 2
  • 87% of patients had less than mild LVOTO at median 5-year follow-up 2

Functional Outcomes

  • 100% of survivors demonstrated normal biventricular function at latest echocardiographic follow-up 2
  • Ventricular function is preserved despite reoperation burden 2

Important Clinical Considerations

Genetic Factors

  • 48% of patients have genetic abnormalities, with DiGeorge syndrome being particularly common (8 of 21 patients in one series) 3
  • Genetic factors may affect long-term survival, with all 3 late deaths in one series occurring in patients with genetic syndromes and IAA/LVOTO 3

Comparison to Alternative Strategies

The Yasui procedure is chosen over single-ventricle palliation (Norwood with subsequent Fontan) when two adequate ventricles are present, as biventricular repair offers superior long-term hemodynamics despite the burden of reintervention 2, 3

References

1
Research

Surgical Reinterventions After Primary vs Staged Yasui Operation.

The Annals of thoracic surgery, 2025

4
Research

Yasui procedure.

Multimedia manual of cardiothoracic surgery : MMCTS, 2016

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.