Minimally invasive surgery with a tube-free surgical field for Tetralogy of Fallot repair: A single-center experience

ABSTRACT Objective Several authors have detailed their experiences with small cohorts of patients in light of expanding interest in using minimally invasive surgery (MIS) to treat Tetralogy of Fallot (ToF). The goal of this study was to review an innovative MIS technique that results in a small tube-free surgical field. The technique’s clinical outcomes were examined in the largest cohort to date of patients with ToF treated with an MIS technique. Methods We reviewed all patients who underwent MIS at a single center between 2013 and 2017. The MIS procedure (including establishment of cavopulmonary bypass) is described. The inter-, peri- and postoperative data are reported and compared with those in the contemporary literature on ToF MIS. Results A total of 105 patients with ToF were identified. All patients, including 2 under 6 months of age, had good postoperative oxygen saturation (99% [98-100]). The incision size was 3 mm for patients younger than 3 years and 3-5 mm for older patients. No conversions to sternotomy or reinterventions were needed. Postoperative complications occurred in 14 patients (13.3%), including 1 death in the intensive care unit, which was not felt to be cardiac in origin. The primary hospital course metrics were comparable to previously published data. Conclusions The MIS technique with a tube-free surgical field has been successfully performed in 105 patients. The overall outcomes are favorable, including those for 2 patients younger than 6 months. This innovative MIS could be a promising approach for facilitating ToF repair in patients of all ages. Central Picture Artist depiction of operative incisions for the proposed minimally invasive surgery. Central Message This study shows the favorable outcomes of an innovative MIS technique with a tube-free surgical field by reviewing its use in 105 ToF patients, to date the largest cohort undergoing MIS for ToF. Perspective Statement The proposed MIS technique with a tube-free surgical field presents a promising method for ToF repair; smaller incisions reduce patient pain, facilitate recovery, and enhance cosmesis. This technique achieved overall favorable outcomes for patients with ToF. Also, it can be a good option for early primary ToF repairs.