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Modified Right Vertical Infra-axillary Thoracotomy Technique For The Surgical Treatment Of Tetralogy Of Fallot In Infants
heqi zhang, weijie liang, Haoju Dong, Taibing Fan.
Central China Fuwai Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China.
BACKGROUND:To evaluate the effectiveness of a minimally invasive surgical approach using a modified vertical infra-axillary thoracotomy for complete repair of tetralogy of Fallot (TOF).
METHODS:This study included 144 patients with TOF who underwent complete repair using the MRVIAT approach between January 2022 and October 2024.The mean patient age was 5.8 ± 2.6 months, and the mean body weight was 6.6 ± 0.9 kg.The mean pulmonary valve annulus Z-score was -1.6 ± 0.8, and pulmonary valve preservation was achieved in 78% of patients.
RESULTS:There were no postoperative deaths, and no conversion to median sternotomy was required.The mean incision length was 2.8 ±0.7 cm.The mean cardiopulmonary bypass time was 89.6 ± 35.3 minutes, and the mean aortic cross-clamp time was 61.5 ± 23.2 minutes.No moderate or severe pulmonary valve regurgitation was observed postoperatively.Patients remained in good clinical condition during a mean follow-up of 18.5 months.The mean postoperative pulmonary valve flow velocity was 1.9 ± 0.8 m/s.In two patients, progressive pulmonary valve stenosis was identified during follow-up, with a peak velocity of 3.5 m/s; balloon pulmonary valvuloplasty was subsequently performed, resulting in normalization of valve velocity.
CONCLUSIONS:Complete repair of TOF via MRVIAT technique is safe, effective, and associated with favorable cosmetic outcomes.The modified technique simplifies the surgical workflow and may facilitate broader adoption of minimally invasive congenital cardiac surgery.
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