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Background: Tetralogy of Fallot is one of the most common congenital heart diseases in which four important cardiovascular defects. Pulmonary valve regurgitation (PVR) after TOF surgery is one of the indications for its replacement which is carried out with two surgical methods, on-pump surgery with and without cardiac arrest., Objective: The aim of this study was to compare the results of the pulmonary valve replacement surgery with and without cardiac arrest., Materials and Methods: In this retrospective study, the information of medical records of all patients with TOF that candidates for pulmonary valve replacement from 2008 to 2014, whom treated in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran and Shaheed Rajaei Heart Center in Tehran with the two common surgical procedure, with and without cardiac arrest, were studied. With matching for age and sex, 33 patients enrolled in this study, 16 patients underwent surgery with the arrest (in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran) and 17 subjects operated without cardiac arrest (on pump beating heart in Shaheed Rajaei Heart Center in Tehran)., Results: The results of this study showed that patients operated using without cardiac arrest compared to the with cardiac arrest, were superior in the hospital and ICU stay, bleeding until 24 hours after surgery, intubated time, inotropic support, and duration of surgery (P<0.05). Also, hemoglobin, blood pressure, ejection fraction (EF), and tricuspid regurgitation after surgery were statistically significant difference between two groups (P<0.05)., Conclusion: The results of this study showed that although during the (on pump beating heart without aortic cross clamp) without cardiac arrest surgery method some problems may be created for the surgeon, nevertheless, patients after without arrested procedure have a better outcomes compared to the cardiac arrest method., Competing Interests: None.