Abstract
Background: Recently, several authors have detailed their experiences with small cohorts of patients in using minimal invasive surgery (MIS) to treat Tetralogy of Fallot (TOF) with innovative approaches and satisfactory results. The goal of this study was to review an new innovative MIS technique that results in using minimal right vertical infra-axillary incision (RVIAI). 
 Methods: Our retrospective study reviewed 45 patients that were diagnosed with TOF and underwent minimally invasive surgery through RVIAI at Children City Hospital from June 2020 to June 2023. 
 Results: Mean age was 9,4 ± 6,6 months, mean body weight was 7,4 ± 1,7 kg, the male/female ratio was 2,1/1. Mean size of pulmonary annulus was 9,58 ± 1,53 mm (-0,47 ± 1,04 Zscore). Central cannulation was accessed in all patients. There were no deaths or conversions to sternotomy. Average durations of aortic cross-clamp and cardiopulmonary bypass (CPB) were 188,7 ± 50,6 min and 124,6 ± 35,8 min, respectively. During the follow-up of 5.4–32.3 months, 11,1% of these patients were found to have moderate residual pulmonary stenosis. There was no severe residual pulmonary stenosis, residual shunt, severe tricuspid regurgitation. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up.
 Conclusions: The right axillary incision allows a safe and effective approach for Tetralogy of Fallot complete repair and is a potential new standard of care for many patients.
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