Arterial Switch Procedure

An arterial switch procedure repairs d-transposition of the great arteries. A surgeon puts a baby’s aorta and pulmonary artery in the correct places. Without involving the heart valves, a surgeon disconnects these major blood vessels and attaches them to the correct heart chambers. This allows a baby born with d-TGA to get the oxygen they need.

Overview Procedure Details Risks / Benefits Recovery and Outlook When To Call the Doctor

An arterial switch procedure is a rare operation to move your baby’s aorta and pulmonary artery to their typical places. A surgeon attaches your baby’s aorta to their left ventricle (lower heart chamber). Then, the surgeon attaches your baby’s pulmonary artery to their right ventricle. Surgeons perform this open-heart surgery during the first two weeks after your baby’s birth.

An arterial switch procedure corrects d-transposition of the great arteries (D-TGA). This is a congenital (present at birth) condition where two large arteries leaving your baby’s heart are in the wrong places. The surgery improves oxygen levels in your baby and helps their heart work better.

When blood goes to the right places, it can get oxygen from your baby’s lungs and distribute it to their body. This operation makes that possible, giving your baby a strong chance to grow into an adult.

Soon after your baby’s birth, a provider will use other therapies to help your baby get more oxygen before surgery. Providers can offer:

  • Septostomy (a temporary procedure to improve oxygen flow).
  • Breathing assistance with a ventilator.
  • Medications like inotropes or prostaglandin.

To prepare for surgery, a provider may use an echocardiogram to look at the size and function of parts of your baby’s heart. They may also take a chest X-ray or electrocardiogram (EKG). These noninvasive tests are painless.

During an arterial switch procedure, a cardiothoracic surgeon will:

  1. Open your baby’s chest with a sternotomy.
  2. Start cardiopulmonary bypass.
  3. Disconnect your baby’s aorta and pulmonary artery without involving their nearby heart valves.
  4. Remove the coronary arteries from the native aorta that links to the right ventricle (the wrong place) in babies with d-TGA.
  5. Attach the coronary arteries to what will be your baby’s “new” aorta.
  6. Reconnect your baby’s aorta to their left ventricle, which typically pumps oxygen-rich blood to their body.
  7. Reconnect your baby’s pulmonary artery to their right ventricle, which typically carries oxygen-poor blood to their lungs for oxygen.
  8. Close your baby’s chest.

If your baby has an atrial septal defect (hole between heart chambers), a surgeon will close it during this surgery.

An arterial switch procedure takes many hours. You can expect your baby to be in the operating room for at least half of a standard workday.

After surgery, your baby will likely spend time in an intensive care unit. You can expect to see tubes, wires and machines attached to your child. While this may be difficult to see, it’s helpful to remember that each piece of equipment has a role in helping your baby get better.

The arterial switch procedure is a lifesaving operation. It allows oxygen from your baby’s lungs to get into their blood and to their whole body. Without surgery, 50% of babies with d-TGA won’t survive the first month after birth.

Long-term results are excellent after an arterial switch procedure. It has a mortality rate (risk of death) below 2%. Risks may be higher for more complex cases.

Healthcare providers have reported that about 96% of people who had an arterial switch procedure were alive 25 years later. Most children who have this surgery don’t need to limit their physical activity over time.

Complications, which may happen a year later or more, may include:

  • Blockages in coronary arteries or the right ventricular outflow tract.
  • Widening or narrowing of relocated vessels.
  • Leaky heart valves.

Your child may need another surgery later to fix these issues. They also may need other types of care for problems like depression, anxiety and difficulty with cognitive skills like memory and attention. These tend to happen in babies who start life with a low oxygen level. Knowing this in advance can help you prepare to watch for problems and arrange for the help your child needs.

Arterial switch procedure recovery time starts in the hospital with a two-week stay. Recovery will continue at home with instructions about caring for your baby’s incision and giving them the medicines they need.

Follow-up appointments

A week or two after going home, your baby will have a checkup with their surgeon. They’ll also need a visit with their pediatric cardiologist in those first few weeks at home.

Your child will need regular checkups each year with a provider throughout their lifetime. This allows their provider to catch any issues before they worsen. They may do noninvasive tests every two years or so to make sure your child’s oxygen level is good.

When should I call my healthcare provider?

After surgery, contact your surgical team if your child has redness, swelling or fluid around their wound or a fever.

  • American Heart Association. D-Transposition of the Great Arteries (https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/d-transposition-of-the-great-arteries). Accessed 8/5/2024.
  • Fraser CD Jr. The Neonatal Arterial Switch Operation: How I Teach It (https://pubmed.ncbi.nlm.nih.gov/27549516/). Ann Thorac Surg. 2016 Sep;102(3):681-684. Accessed 8/5/2024.
  • Fricke TA, Konstantinov IE. Arterial Switch Operation: Operative Approach and Outcomes (https://pubmed.ncbi.nlm.nih.gov/30009809/). Ann Thorac Surg. 2019;107(1):302-310. Accessed 8/5/2024.
  • Moe TG, Bardo DME. Long-term Outcomes of the Arterial Switch Operation for d-Transposition of the Great Arteries (https://pubmed.ncbi.nlm.nih.gov/30227186/). Prog Cardiovasc Dis. 2018;61(3-4):360-364. Accessed 8/5/2024.
  • Murthy R, Moe TG, Van Arsdell GS, Nigro JJ, Karamlou T. Congenital Heart Disease. In: Brunicardi F, Andersen DK, Billiar TR, et al., eds. Schwartz’s Principles of Surgery. 11th ed. McGraw-Hill Education; 2019.
  • O’Byrne ML, Glatz AC, Song L, et al. Association Between Variation in Preoperative Care Before Arterial Switch Operation and Outcomes in Patients With Transposition of the Great Arteries (https://pubmed.ncbi.nlm.nih.gov/30474422/). Circulation. 2018;138(19):2119-2129. Accessed 8/5/2024.
  • Radiopaedia. Arterial switch procedure (https://radiopaedia.org/articles/arterial-switch-procedure?lang=us). Last revised 1/21/2023. Accessed 8/5/2024.
  • The Society of Thoracic Surgeons. Transposition of the Great Arteries (https://ctsurgerypatients.org/pediatric-and-congenital-heart-disease/transposition-of-the-great-arteries). Last reviewed 12/2017. Accessed 8/5/2024.

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