Minimally Invasive Surgery with a Tube-Free Surgical Field for Tetralogy of Fallot Repair: A Single-Center Experience

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. ![Figure][1] 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Jinan Military General Hospital, Jinan, China, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * CHD : congenital heart diseases CPB : cardiopulmonary bypass ICU : intensive care unit LAA : left atrial appendage MIS : minimally invasive surgery PFO : patent foramen ovale RV : right ventricular RVOT : right ventricular outflow tract ToF : Tetralogy of Fallot [1]: pending:yes