Chasing a moving target: outcome and risk stratification in patients with transposition of the great arteries after atrial switch operation

This editorial refers to ‘The natural and unnatural history of the Mustard procedure: long-term outcome up to 40 years’†, by J.A.A.E. Cuypers et al., on page 1666 Before the advent of the atrial switch operation, hardly any infant born with complete transposition of the great arteries (TGA) survived beyond the first year of life. In the 1950s and 1960s, two operations introduced by Senning and Mustard, respectively, revolutionized the outcome of the condition, allowing patients to survive well into adulthood.1,2 However, ongoing long-term complications, as well as increased morbidity and mortality remain an issue even five decades later. This type of physiological repair has now been largely replaced by the arterial switch procedure.3 Today it continues to be reserved only for highly selected cases and has, thus, become part of medical history more than being a viable treatment option.