The arterial switch operation (ASO) is considered the gold standard for repair of D-transposition of the great arteries. However, when patients present after the third week of life, the early operative outcomes may be less predictable. Current guidelines recommend extra corporeal membrane oxygenation (ECMO) availability when the arterial switch is performed on patients between 3 to 6 weeks of age. Controversy remains regarding the safe upper age limit for a successful arterial switch operation. An objective assessment of the efficacy of a treatment requires a comparison of the treatment outcome with the natural history. We reviewed the literature and used the most externally valid data to create a composite survival curve that facilitates the comparison of surgical outcome and natural history. The data suggest that, where ECMO is available, the ASO is the best option for patients at any age up to 14 weeks old. The ASO is also the best option for patients up to 2 weeks of age where ECMO is not available. The atrial switch operation (AtSO) is the best option for patients between 2 weeks and 14 weeks of age where ECMO is not available. The ASO or the AtSO should be offered as soon as possible after birth; surgery after 14 weeks of age may not improve 10 year survival compared to the natural history.
Key words: Pediatric, transposition great arteries, operative, outcomes.
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