J.Jpn. Surg. Soc.. 102(8): 584-589, 2001

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Feature topic

SURGICAL TREATMENT OF TRANSPOSITION OF THE GREAT ARTERIES:THE ARTERIAL SWITCH OPERATION

Transposition of the great arteries (TGA) is one of the most common congenital cardiac anomalies resulting in cyanosis. Various atrial-level physiological procedures were developed in the late 1950s and early 1960s, including the Senning and Mustard procedure.
In 1975, Jatene et al. reported the first successful arterial switch procedure in a patient with d-TGA and ventricular septal defect. In 1977, Yacoub et al. introduced a two-stage repair comprising initial pulmonary artery banding to retain the left ventricle, supplemented by a systemic-pulmonary artery shunt, thereby potentially expanding the arterial switch procedure to a much wider population of patients. In 1983, the concept of the primary neonatal arterial switch procedure was introduced by Castaneda et al. Since then, the primary artery switch procedure in neonates and early infants has become the standard for the treatment of TGA. This is due to the fact that the only the arterial switch procedure allows complete anatomical repair.
In Japan, 102 neonates with simple TGA underwent the arterial switch procedure, with hospital death occurring in 21 (20.6% mortality rate) according to the 1998 annual report. In Okayama University Hospital, 48 neonates, underwent the arterial switch procedure, with 1 hospital death (2.1% mortality rate) and no late deaths since 1991.

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