While minimally invasive techniques for simple septal defects have demonstrated comparable safety and efficacy to median sternotomy, clinical outcomes following minimally invasive repair of Tetralogy of Fallot (TOF) remain insufficiently characterized.

This retrospective single-center cohort included patients who underwent complete TOF repair through a modified right vertical infra-axillary thoracotomy (RVIAT) between January 2022 and December 2024.

All 144 patients (mean age, 8.7 ± 7.8 months; mean weight, 7.6 ± 2.4 kg) underwent RVIAT repair without conversion to median sternotomy. Mean cardiopulmonary bypass and aortic cross-clamp times were 90.8 ± 30.2 and 67.4 ± 24.2 minutes, respectively. Mean postoperative hospital stay was 9.9 ± 3.4 days. The most frequent early complications were postoperative pneumonia (16/144, 11.1%) and transient arrhythmia (5/144, 3.5%). Three patients underwent early transcatheter occlusion of major aortopulmonary collateral arteries because of difficulty weaning from mechanical ventilation. Two patients underwent balloon pulmonary valvuloplasty for residual pulmonary stenosis. At a mean follow-up of 25.3 ± 9.6 months, mean pressure gradients across the right ventricular outflow tract (RVOT) and pulmonary valve were 6.33 ± 7.86 and 17.01 ± 9.45 mmHg, respectively. Mild or moderate residual RVOT stenosis was present in 8.3% of patients, and moderate pulmonary regurgitation occurred in 0.7%.

Modified RVIAT repair of TOF was feasible in carefully selected patients and was associated with favorable early outcomes. Comparative studies and longer follow-up are required to define its advantages and durability relative to median sternotomy.