AbstractBackground: Mini-invasive pediatric cardiac surgery has been slow to gain pace due to limited surgical exposure and long learning curve. We started performing transverse sternal split (TSS) to improve surgical exposure with advantage of mini incision in tetralogy of Fallot (TOF) and here we have reviewed our short and mid -term results. Methods: Retrospectivereview of patientsof TOF (n=23) operated using TSS (Group 1) from January-2015 to Dec- 2016 was performed. Patients were compared with matched patients operated using midline sternotomy (Group 2). Further,TSS group wasdivided into two sub-groups: Group 1A-patients operated in 2015 (n=11) & Group 1B-patients operated in 2016(n=12). Pre-operative, intraoperative and post-operative datawere collected and analyzed. Results: There was no significant difference in mortality, residual defects and morbidity between TSS and sternotomy group. Mean preparation (p<0.001), cross clamp (p=0.001), CPB (p<0.001), and surgery time (p<0.001) were significantly higher in TSS group than sternotomy group. However, mean duration of ventilation, ICU and hospital stay were significantly lower (p<0.05) in TSS group. Whileanalyzing TSS sub-groups, mean preparation, cross clamp, CPB and surgery time were significantly lower (p<0.05) in group 1B as compared to group 1A, however all remained higher than sternotomy group. Cosmetic result was satisfactory without sterna dehiscence in TSS group and all were in NYHA-Iat mean follow-up of 17.6±7.4 months. Conclusions: The TSS is good alternative to a midlinesternotomy for TOF repair in selected patients with satisfactory cosmetic results without compromising the surgical exposure or quality of repair. With increase in expertise, operative duration can be decreased although it remains higher than midline sternotomy.
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