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November 20, 2025Pediatric CardiologyOpen Access

Long-Term Outcomes After Arterial Switch Operation: Risk Factors and the Impact of Anatomical Complexity in a Single-Centre Cohort

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Key result

Complex transposition of the great arteries was associated with a significantly lower freedom from surgical reoperation at 15 years compared to simple transposition (91% vs 98.3%).

Why the study?

Long-term outcomes after the arterial switch operation for transposition of the great arteries, along with anatomical and clinical factors associated with adverse outcomes comparing simple and complex anatomy, needed evaluation.

Does the arterial switch operation provide excellent long-term survival and low reintervention rates in patients with simple versus complex transposition of the great arteries?

Population

233 patients who underwent arterial switch operation (158 simple TGA and 75 complex TGA)

Comparison

Simple TGA vs complex TGA

Design

Single-centre cohort study

Follow-up

Up to 15 years

Authors

VOValentina OrioliLCLucio CaredduVMValeria Francesca Mangerini

Discussion

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Overview

Closer follow-up may be warranted after ASO in complex TGA; leaves open whether coronary anatomy independently drives late reoperation.

Study Design

Type

Cohort (n=233)

Multicenter

No

Structured PICO

Does the arterial switch operation provide excellent long-term survival and low reintervention rates in patients with simple versus complex transposition of the great arteries?

P
Population
233 neonates with simple or complex transposition of the great arteries who underwent arterial switch operation, followed for a mean of 8.5 years.
E
Exposure
Arterial switch operation (ASO)
C
Comparator
Simple TGA versus Complex TGA
O
Outcome
Overall survival and freedom from surgical reoperationhard clinical

Main Result

Absolute Event Rate: 91% vs 98.3%

p-value: p=0.039

The arterial switch operation provides excellent long-term survival and low reintervention rates, though complex anatomy and specific coronary patterns increase the risk of mortality and reoperation.

Limitations

  • Retrospective, single-center analysis limiting generalizability
  • Small number of adverse events limits the statistical power of the risk factor analysis
  • Lacks external validation
  • Selection bias regarding surgical technique (button technique preferentially used in anatomically complex cases)
  • Retrospective single-center design

Cite This Study

Orioli et al. (2025) conducted a cohort in Transposition of the great arteries (n=233). Complex transposition of the great arteries vs. Simple transposition of the great arteries was evaluated on Freedom from surgical reoperation at 15 years (p=0.039). Complex transposition of the great arteries was associated with a significantly lower freedom from surgical reoperation at 15 years compared to simple transposition (91% vs 98.3%).

synapsesocial.com/papers/6a809755527a4b4caa31d45ehttps://doi.org/10.1007/s00246-025-04095-x
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