Comparative Outcomes of Left Anterior Thoracotomy Versus Resternotomy for Pulmonic Valve Replacement After Tetralogy of Fallot Repair

Objective: Redo pulmonary valve replacement (PVR) in patients with prior tetralogy of Fallot (TOF) repair is surgically challenging. This study aimed to compare the clinical outcomes of the left anterior minithoracotomy (LAT) approach with the traditional resternotomy approach for PVR. Methods: A retrospective analysis was conducted on 38 TOF patients who underwent redo PVR, categorized into LAT ( n = 20) and resternotomy ( n = 18) groups. Patients requiring concomitant valvular surgeries or repair of residual intracardiac shunts were excluded. We compared demographics, operative details, and postoperative outcomes. Results: Baseline demographics were comparable between groups, except for a higher proportion of males in the LAT group (75% vs 38.9%, P = 0.047). The LAT approach demonstrated nonsignificant favorable trends, including shorter operative times (157.05 ± 49.42 vs 178.06 ± 58.69 min, P = 0.239) and shorter postoperative hospital stays (4.75 ± 1.21 vs 6.17 ± 4.38 days, P = 0.173). Vasoactive-inotropic scores were significantly lower in the LAT group both immediately postoperatively (0.05 ± 0.22 vs 4.36 ± 6.95, P = 0.009) and on postoperative day 1 (0 vs 2.17 ± 4.52, P = 0.039). Postoperative complications, such as atrial fibrillation and pleural effusion, were similar between groups. There was no mortality in either group. Conclusions: The LAT approach for PVR after TOF repair is a safe alternative to resternotomy. Comprehensive preoperative imaging evaluation is crucial for determining the optimal incision site. Further studies with larger cohorts are needed to confirm the potential benefits of this approach.