Tetralogy of Fallot (ToF) represents 5–7% of all congenital heart diseases and is the most common form of cyanotic congenital heart disease. Coronary artery (CA) anomalies occur in 5–12% of ToF cases [1–7]. Because this anomalous CA (ACA) most frequent ly crosses the infundibular region, it can lead to technical difficul ties during the surgical repair and to increased morbidity and mortality rates. A CA lesion can occur if this abnormal course was undiagnosed before or during surgery, leading to se vere myocardial ischaemia and inadequate or imperfect surgical correction of the right ventricular outflow tract (RVOT) obstruction [8]. Several surgical repair procedures have been described in the literature to relieve RVOT obstruction without damaging the ACA, the most common being insertion of a right ventricle (RV)-to-pulmonary artery (PA) prosthetic conduit over the ACA or infundibular resection through a right atriotomy and, when surgically possible, an infundibular incision either above or below the ACA, or both [1, 9–17]. An RV-to-PA conduit insertion implies future reinterventions, leading to significant surgical cumulative risk because the conduit is likely to require revision. The twin aims of this retrospective study were to report the outcomes for ToF repair with associated ACA in our institution and to evaluate the results of different surgical techniques aimed at avoiding the use of RV-to-PA prosthetic conduits. MATERIALS AND METHODS A retrospective monocentric study was conducted in our institu tion from 2000 to 2016. We reviewed our paediatric cardiac sur gery database to identify the patients with ToF who underwent biventricular repair. The Paris V University ethics committee granted approval for review of health records. The need for indi vidual consent was waived due to the retrospective nature of the study. From 2000 to 2016, 1132 patients with ToF underwent surgery in our institution. We excluded patients with ToF with pulmonary atresia and/or atrioventricular (AV) septal defect, patients who had prior surgical repair in another institution and patients who could not benefit from biventricular repair. Patients with ToF dis playing a minor infundibular coronary branch were not included. On the 943 patients with ToF included in our cohort, 76 (8%) had an ACA. An ACA was either diagnosed from preoperative transthoracic echocardiography or discovered at surgery. CA anatomy is described in Table 1. The main ACA were a left CA arising from the right CA (n=47, 61.8%), a major infundibular CA (n=15, 19.7%), a right CA arising from the left CA (n=5, 6.5%), a single CA from 1 sinus (n=5, 6.5%) or a right CA arising from the left sinus (n=4, 5.2%). The mean follow-up period was 50months (1month–18years)