The arterial switch operation is judged the best palliative operation for neonates
with transposed great arteries. We aimed to assess the value of analysing a large
series of unselected cases by this technically demanding operation and formulate a
We reviewed all 432 neonates (mean age at operation 7 days, mean weight 3.25 kg) who
underwent an arterial switch operation between 1987 and 1999. Follow-up (mean time:
4.9 years) was complete in 412 patients.
Survival probability and freedom from reoperation was 94% and 78% at 10 years, respectively.
26 patients died, 16 because of myocardial ischaemia. Risk factors for death included
early experience, low weight, associated cardiovascular malformations (especially
hypoplasia of the right ventricle or aortic arch), and difficult patterns of coronary
arteries. The risk of the coronary artery pattern was greatly reduced in those who
had recent operations. At last follow-up, 90% of patients had normal life without
treatment, and 94% a normal heart function on echocardiography.
The arterial switch operation in neonates achieves excellent results mid-term. Obstruction
of the translocated coronary arteries is responsible for most deaths and a substantial
number of reoperations. Although confirmation is needed, these results allow anticipation
of a favourable long-term prognosis.