Arterial Switch Operation in the First 2 Days of Life

Early arterial switch operation (ASO) is standard therapy for neonates with transposition of the great arteries, yet the safety and potential value of repair within the first 48 hours of life remain incompletely defined. This study evaluated outcomes of very early ASO (≤48 hours) compared with repair operations performed on postnatal days 3 to 7.

This study retrospectively reviewed neonates undergoing ASO at a single tertiary congenital cardiac center between 1992 and 2022. Outcomes of patients who underwent repair operations within ≤48 hours were compared with infants who underwent repair operations on days 3 to 7. Primary outcomes included mortality and reintervention; secondary outcomes included postoperative morbidity and hospital length of stay.

Among 633 neonates, 78 (12.3%) underwent ASO within ≤48 hours and 396 (62.5%) underwent ASO between days 3 and 7. Early repair was associated with similarly low postoperative morbidity and no increase in mortality, with no early deaths in the ≤48-hour group. Hospital stay was shorter in neonates who underwent repair operations within ≤48 hours (7 days vs 9 days; P = .004). After propensity matching, clinical outcomes and reintervention rates remained comparable between the groups, with a persistent numeric trend toward shorter stay. With long-term follow-up (median 17.7 years in the ≤48-hour group), freedom from coronary and noncoronary reintervention was similar between timing groups.

In appropriately selected neonates, ASO within the first 48 hours of life is safe and effective, with outcomes comparable to those with repair procedures on postnatal days 3 to 7 and a potential trend toward shorter hospitalization. In experienced centers, very early ASO represents a pragmatic alternative to conventional early neonatal timing.