Current technique of the arterial switch procedure for transposition of the great arteries

The arterial switch operation has recently become the preferred method of repair for patients with transposition of the great arteries in the majority of congenital heart centers. Concern regarding the late results in those patients undergoing atrial repairs has stimulated this major change in operative treatment. Although initially high, the current operative mortality has been reduced substantially to equal that of atrial repair in experienced institutions. The precise methods of coronary artery transfer, as well as aortic and pulmonary artery reconstruction have been refined to allow the routine performance of direct arterial repair within the first few weeks of life with low risk and excellent late survival. At the University of Michigan, a policy of arterial repair for all suitable infants with transposition of the great arteries with or without ventricular septal defect was adopted in July 1985. Although modifications in surgical technique have been made, the basic procedure has remained constant. This article reviews the current operative approach used in a consecutive series of 81 patients undergoing the arterial switch procedure.