Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. While outcomes after surgical repair are excellent in developed countries, access to early diagnosis and corrective surgery remains limited in many developing regions. Humanitarian programs such as Mécénat Chirurgie Cardiaque (MCC) aim to address these disparities by providing access to complete surgical repair for children from disadvantaged countries. Data on long-term outcomes in this specific population remain limited.

We conducted a retrospective cohort study including patients who underwent complete surgical repair of TOF through the MCC program in France between 1996 and 2010. All patients originated from countries without access to full corrective congenital cardiac surgery. The primary outcome was long-term overall survival after repair. Secondary outcomes included early postoperative mortality, major postoperative complications, and identification of predictive factors for mortality and complications. Survival was analyzed using the Kaplan–Meier method and Cox proportional hazards models. Logistic regression was used to assess predictors of major early postoperative complications.

A total of 314 patients from 37 countries were included. Median age at surgery was 4.48 years, 70.71% of patients had a weight below the 10th percentile and the median preoperative oxygen saturation was 78%. Overall mortality occurred in 12 patients (3.84%). The median follow-up duration was 6.45 years. Event-free survival was 95.8% at 10 years and 92.3% at 20 years. In univariable analysis, transannular incision and longer cardiopulmonary bypass duration were associated with mortality, but no variable remained statistically significant in multivariable analysis. Early postoperative mortality occurred in 7 patients (2.22%). Major postoperative complications were associated with lower preoperative oxygen saturation, smaller pulmonary annulus, transannular incision, and longer bypass duration in univariable analysis, with no independent predictors identified in multivariable models.

Late complete repair of TOF performed in a humanitarian context was associated with excellent early and long-term survival, despite severe preoperative compromise, with outcomes comparable to those in high-income countries. No independent predictors of mortality or major postoperative complications were identified.