Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes. Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects. Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death. Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”

Introduction: Minimally invasive approach to Aortic Valve Replacement (AVR) is increasingly accepted as a valid alternative to full sternotomy approach, as to reduce operative trauma with the final aim to improve post-operative outcomes. The aim of this work is to evaluate the feasibility of minimally invasive aortic valve surgery through a right mini-thoracotomy, and hence to minimize the surgical access to achieve better cosmetic results, less postoperative discomfort and faster recovery while maintaining the same level of safety and favorable results as with conventional surgery. Methods: In this study a 150 patients with Aortic Valve Disease (AVD) requiring aortic valve surgery were none randomly selected. The study was performed at Benha University Hospital & the Armed Forces Hospitals. Seventy five patients underwent aortic valve surgery by traditional median sternotomy with central cannulation (group B), the other seventy five patients by right mini-thoracotomy on 2 nd or 3 rd right intercostal space with peripheral femoral cannulation (group A). Endpoints were overall postoperative complications, major adverse cardiac related complications, use of blood products and need for transfusions, bypass time and cross clamp time, ventilation time and length of hospital-stay. Results: Minimally invasive AVR was associated with a significant reduction in need for blood and blood products transfusions, as well as postoperative cardiac and non-cardiac complications. Post-operative pain was significantly reduced in the mini-invasive group, a trend to lower mean ventilation times, ICU stay and hospital-stay in the miniinvasive group was also detected. Conclusion: Minimally invasive aortic valve surgery has evolved into a well tolerated, efficient surgical treatment option in experienced centers, providing greater patient satisfaction and lower complication rates. Potential advantages of Minimally Invasive Aortic Valve Replacement (MIAVR) arise from the concept that patient morbidity and potential mortality could be reduced without compromising the excellent results of the conventional procedure and include improved cosmetic results, safer access in the case of re-operation, less postoperative bleeding, less blood transfusions, lower intensive care unit and in-hospital stays, as well as the absence of sternal wound infection.