Selcuk A, Ozturk M, Tongut A, Sterzbecher V, Park IH, Mehta R, Desai M, Yerebakan C, d’Udekem Y.World J Pediatr Congenit Heart Surg. 2024 Jul;15(4):421-429. doi: 10.1177/21501351241239307. Epub 2024 May 16.PMID: 38751363
Take Home Points
- The arterial switch operation (ASO) achieves a high survival rate in patients with dextro-transposition of the great arteries (d-TGA), with 96.6% surviving beyond the first year.
- One in five patients (21%) required reintervention, mainly due to pulmonary artery (PA) stenosis. Patients with Taussig-Bing anomaly (TBA) had a notably higher reintervention rate, identifying a high-risk subgroup within the d-TGA population
- Consistent, long-term follow-up is essential after the ASO, especially in patients with TBA, to monitor and manage PA complications

Commentary from Dr. Milan Prsa (Switzerland, Europe), section editor of Congenital Heart Disease Interventions Journal Watch:
The ASO is the standard corrective surgery for d-TGA. This study aimed to evaluate the effectiveness of ASO, focusing on survival rates and the incidence of reinterventions for PA stenosis, a common postoperative complication.
This retrospective review included 180 patients who underwent ASO for d-TGA between 2002 and 2022 at a single center. Patients were divided into three groups: those with an intact ventricular septum (TGA-IVS), those with a ventricular septal defect (TGA-VSD), and those with Taussig-Bing anomaly (TBA). Kaplan-Meier survival analysis was used to assess overall survival and reintervention-free survival, while regression analyses identified risk factors for PA stenosis and intervention.
The study found a one-year survival rate of 96.6%, underscoring the efficacy of ASO in managing d-TGA. However, reinterventions were necessary for 43 patients (24%), primarily due to PA stenosis (86%, 37/43). These 37 patients (21%) underwent 53 PA reinterventions, including 14 reoperations and 39 transcatheter angioplasties (33 ballon dilations and 6 stent implantations). Eight patients (22%, 8/37) required early (prior to discharge) PA reintervention, at a median postoperative day of 31 (IQR 8-39). The median time from ASO to PA angioplasty was six months (IQR 2-13), and from ASO to reoperation was one year (IQR 0.1-8). Freedom from PA reintervention decreased significantly over time, dropping from 97% at one year to 55% at 15 years, indicating a progressive risk for PA stenosis with age. Risk factors for PA reintervention were TBA (OR 6.4), mild PA stenosis at discharge (OR 6.1) and moderate or severe PA stenosis at discharge (OR 12.7).
Despite limitations as a single-center retrospective review, this study highlights the long-term success of ASO for d-TGA and the challenges of managing postoperative complications, particularly PA stenosis. It provides valuable insights into the progression of PA stenosis over time, emphasizing the need for careful monitoring and individualized care, especially for patients with more complex anatomy like TBA. The authors suggest that the surgical techniques, such as the level of arterial transection and the type of patch used in neo-PA reconstruction (e.g. glutaraldehyde-treated pericardium) may contribute to PA stenosis. Future studies could focus on refining surgical techniques to reduce PA stenosis, thus improving patient outcomes and minimizing the need for reintervention.