title: Contemporaneous comparison of the Yasui and Norwood procedures at a single institution.
abstract: OBJECTIVE
  It is recognized that there are numerous anatomic variants that result in hypoplastic left heart physiology. One such variant includes critical aortic stenosis or atresia, a hypoplastic aortic arch, and a reasonably well-developed left ventricle due to the presence of a ventricular septal defect. These patients are candidates for 1 of 3 surgical options: (1) a Norwood procedure followed by a single-ventricle pathway; (2) a Norwood procedure followed by a Rastelli procedure (2-stage Yasui); or (3) a single-stage Yasui procedure. Because 2 of the 3 options include a Norwood procedure as the initial step, the purpose of this study was to evaluate the contemporaneous results of the Yasui and Norwood procedures at a single institution.
  
  
  METHODS
  This was a retrospective review of patients who underwent a Yasui or Norwood procedure at Lucile Packard Children's Hospital between 2004 and 2013. Eighteen patients underwent a Yasui, of whom 15 had a single-stage procedure and 3 had a 2-stage procedure. During this time frame, 113 patients underwent a Norwood procedure. Kaplan-Meier survival curves and freedom from reoperation were compared for the 2 procedures.
  
  
  RESULTS
  The operative mortality (using the Society of Thoracic Surgeons definition) for the single-stage Yasui was 6.7% compared with 16% for the Norwood procedure (P < .05); survival was 85% versus 62% at 1 year, 85% versus 60% at 3 years, and 85% versus 58% at 5 years, respectively (log-rank P = .06). The average interval to first reoperation was 13.5 ± 3 months versus 4.5 ± 1 months for the Yasui and Norwood procedures, respectively (P < .001).
  
  
  CONCLUSIONS
  The Yasui procedure had a significantly lower operative mortality compared with the Norwood procedure. Early and midterm survival was also higher in the Yasui group versus the Norwood followed by a single ventricle pathway. These results indicate that the Yasui procedure has significant midterm benefits compared with the Norwood procedure and should be pursued when the anatomy is amenable for this approach.
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Carrillo
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif. Electronic address: mainwaring@stanford.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Mainwaring
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Schaffer
authors.affiliation: Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: Gail
authors.initials: G
authors.lastname: Wright
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, Calif.
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D010043:Outcome and Process Assessment, Health Care; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate