Bidirectional Glenn and pulmonary artery banding as a bridge to arterial switch in late-diagnosed dextro-transposition of the great arteries with intact ventricular septum

Aim: To evaluate the safety and efficacy of two-stage arterial switch operation using bidirectional Glenn anastomosis combined with pulmonary artery banding in late-diagnosed dextro-transposition of the great arteries with intact ventricular septum. Method: This single-centre retrospective study included 24 children with late-diagnosed dextro-transposition of the great arteries with intact ventricular septum treated between 2020 and 2025, all with left ventricular mass index <35 g/m 2 and banana-shaped geometry. Demographics, interventions, imaging, postoperative course, and follow-up data were collected. Haemodynamics, left ventricular retraining, complications, and survival were evaluated. Results: The cohort included 9 boys (37.5%) and 15 girls (62.5%), with a median age at first-stage surgery of 5 months (4–9.75). Patent ductus arteriosus was more common in patients without prior interventions (61.54% vs. 0%, p = 0.002). Additional surgical interventions performed concurrently with the first-stage BDG + pulmonary artery banding differed by prior-intervention status ( p = 0.016). One mortality (4.17%) occurred due to sepsis in the no-prior group. Twenty-three patients proceeded to second-stage arterial switch (median interval 15 months, median age 22 months). In the prior-intervention group, post-second-stage ICU stay (median 5 vs. 4 days, p = 0.007) and inotrope use (median 4 vs. 3 days, p = 0.027) were longer. Two patients (8.7%) required ECMO (both prior group, resolved). At follow-up (1–4 years), all survivors were NYHA class I, with mild neo-aortic insufficiency in 52.17% and mild neo-pulmonary insufficiency in 13.04%. Conclusion: Bidirectional Glenn anastomosis combined with pulmonary artery banding is a safe and effective strategy for gradual left ventricular retraining in late-diagnosed dextro-transposition of the great arteries with intact ventricular septum. It reduces perioperative morbidity and provides good survival and functional outcomes, which is valuable in resource-limited settings.