Arterial switch operation for transposition of great arteries: late results in adult patients

Complete transposition of the great arteries (TGA) accounts for 5% to 7% of congenital cardiac anomalies, and represents the second most common cyanotic heart defect. Successful surgery, allowing the majority of patients to survive to adulthood, can either involve a physiologic or anatomic “correction”. The former (i.e. atrial switch), introduced in 1958 by Senning and later modified by Mustard, corrects the physiologic abnormality of the TGA by creating an atrial baffle to direct the venous return to the contralateral atrioventricular valve and ventricle. Although mid-term clinical results are excellent, this procedure leaves the RV supporting the systemic circulation. Hence, complications such as progressive RV dysfunction, ensuing tricuspid regurgitation, frequent arrhythmias, heart failure and early mortality may arise in the long-term 5 .