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Transatrial/transpulmonary approach versus transventricular approach in classical tetralogy of fallot repair

Background: Right ventricular dysfunction is an important cause of morbidity and mortality following total correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary approach avoids ventriculotomy (as opposed to the transventricular approach) which gives maximum protection of the right ventricle structure and function. Objectives: The main objective is to review the results of transatrial/transpulmonary approach and compare it with that of the transventricular approach. Patients and Methods: Forty patients underwent repair of classical TOF were retrospectively studied from January 1, 2015 to January 1, 2018 at Ibn Al-Nafees Teaching Hospital for cardiothoracic surgery in Baghdad, Iraq. We divided the patients into two groups: group A (transventricular approach group) – 22 patients, and Group B (transatrial/transpulmonary approach group) – 18 patients. In this study, we did comparison between these two groups. Results: There were eight operative deaths; the overall mortality was 20%, six patients in Group A (27.27%) versus two patients in Group B (11.11%). Severe right ventricular systolic dysfunction after repair was found in 14 patients (35%), 11 patients in Group A (50%) versus 3 patients in Group B (16.66%). Tachyarrhythmias were seen in 18 patients after repair (45%); 13 patients in Group A (59.09%) versus 5 patients in Group B (27.7%). Conclusion: Transatrial/transpulmonary approach procedure in the TOF surgery is more safe and associated with lower morbidity and mortality than the transventricular approach.