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Minimally Invasive Cardiac Surgery for Treating Tetralogy of Fallot in Children in the Modern Era

Hoang Duy Chiem1, Phuong Thuy Nguyen2, Manh Dien Truong3

  • 1Department of Thoracic and Cardiovascular Surgery, City Children's Hospital, Ho Chi Minh City, Vietnam; Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.

The Annals of Thoracic Surgery
|January 9, 2026
PubMed

Insights

Minimally invasive cardiac surgery shows positive early results for Tetralogy of Fallot (TOF) repair in infants. This approach offers a promising alternative to traditional methods, with significant improvements in pressure gradients and valve function.

Area of Science:

  • Cardiac Surgery
  • Pediatric Cardiology
  • Minimally Invasive Procedures

Background:

  • Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical intervention.
  • Evaluating early outcomes of minimally invasive cardiac surgery (MICS) for TOF repair is crucial for establishing new treatment standards.

Purpose of the Study:

  • To assess the early-term results of MICS for definitive treatment of Tetralogy of Fallot (TOF).
  • To compare the efficacy and safety of MICS against traditional surgical methods for TOF.

Main Methods:

  • A cohort of 46 pediatric patients (≥ 3 months old) with TOF underwent surgical repair between May 2023 and May 2024.
  • The surgical approach involved right vertical infra-axillary thoracotomy, a minimally invasive technique.
  • Data collected included cardiopulmonary bypass time, aortic clamp time, postoperative complications, hospital stay, and follow-up outcomes.

Main Results:

  • All 46 patients completed the procedure with one requiring re-intervention for bleeding. Mean bypass and clamp times were 174 and 108 minutes, respectively. Average hospital stay was 10.3 days.
  • Common early complications included pneumonia (26.1%) and junctional ectopic tachycardia (23.9%). No deaths occurred during the average 8.1-month follow-up.
  • Significant improvements were observed: right ventricular outflow tract pressure gradient decreased from 63 to 20 mmHg, and pulmonary valve annulus size increased from 8.7 to 11.6 mm. Mild/moderate stenosis and regurgitation were noted in some patients.

Conclusions:

  • Minimally invasive cardiac surgery demonstrates relatively positive early-term results for Tetralogy of Fallot treatment.
  • MICS presents a promising alternative to conventional open-heart surgery for TOF repair.
  • Further refinement and practice in complex surgical environments are needed to achieve optimal proficiency with this technique.
Abstract

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