BACKGROUND: Pulmonary regurgitation is a common long-term consequence after Tetralogy of Fallot (TOF) repair and often leads to right ventricular dilatation requiring pulmonary valve replacement (PVR). Redo sternotomy carries risks including cardiac injury and bleeding. Minimally invasive alternatives aim to reduce surgical trauma while maintaining procedural safety. CASE PRESENTATION: We report five consecutive patients (aged 9-44 years) with severe pulmonary regurgitation and right ventricular dilatation who underwent minimally invasive PVR via a left anterior mini-thoracotomy (LAMT). All procedures were performed on a beating heart using femorofemoral cardiopulmonary bypass and stented bioprosthetic valves. Mean cardiopulmonary bypass time was 37.8 min. No conversions to sternotomy, major complications, or mortality occurred. Patients were extubated after a mean of 9.6 h, and mean hospital stay was 6.8 days. At two-month follow-up, all patients demonstrated excellent prosthetic valve function and significant reduction in right ventricular size. CONCLUSIONS: LAMT-PVR is a feasible and safe alternative to redo sternotomy for selected post-TOF patients. This approach provides direct access to the pulmonary artery with reduced surgical trauma and favorable early outcomes.