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Tyson A Fricke - One of the best experts on this subject based on the ideXlab platform.
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neo aortic valve repair and ross procedure after the Arterial Switch Operation
Operative Techniques in Thoracic and Cardiovascular Surgery, 2021Co-Authors: Tyson A Fricke, Christian P Brizard, Igor E Konstantinov, Edward BurattoAbstract:Neo-aortic valve regurgitation is common in adolescents and young adults who have undergone the Arterial Switch Operation in infancy. The incidence of significant neo-aortic valve regurgitation increases as these patients age. Neo-aortic valve repair and the Ross procedure are good surgical options in such patients. Herein we describe these surgical techniques.
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long term outcomes of the Arterial Switch Operation
The Journal of Thoracic and Cardiovascular Surgery, 2021Co-Authors: Tyson A Fricke, Andrew Bullock, Edward Buratto, Robert G Weintraub, Gavin R Wheaton, Leeanne Grigg, Patrick DisneyAbstract:Abstract Objectives The Arterial Switch Operation (ASO) has excellent early outcomes in the modern era. We sought to determine the long-term outcomes in patients who underwent an ASO at a single institution. Methods Patients who underwent an ASO between 1983 and 2015 were identified from the hospital database and retrospectively reviewed using hospital records. Results From 1983 to 2015, 844 patients with a biventricular circulation underwent an ASO. There were 28 (3.3%, 28/844) early deaths. Follow-up was available for 94% (729/774) of local patients after hospital discharge. Median follow-up was 15 years (interquartile range, 8-20 years). There were 187 (26%, 187/729) patients with more than 20 years of follow-up and 95 (13%, 95/729) patients with more than 25 years of follow-up. Overall survival was 95% (95% confidence interval [CI], 94%-97%) at 10 and 25 years after the ASO. At 25 years after ASO, freedom from overall reintervention was 77% (95% CI, 73%-81%), freedom from reOperation on the neoaortic root or neoaortic valve was 92% (95% CI, 88%-95%), and freedom from coronary reOperation was 99% (95% CI, 98%-99.7%). Left ventricular (LV) systolic function was normal in 595 of 609 (98%) of patients who had LV function quantified at latest follow-up. Of the 95 patients with more than 25 years of follow-up after ASO, 6 (6.3%) had at least moderate neoaortic valve regurgitation (AR) and 8 (8.4%) had undergone replacement of the neoaortic valve. Conclusions Overall, survivors of ASO have excellent late survival and normal LV systolic function into adult life. However, AR and reOperation on the neoaortic valve remains an issue for older patients.
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outcomes of the Arterial Switch Operation in children less than 2 5 kilograms
The Annals of Thoracic Surgery, 2017Co-Authors: Tyson A Fricke, Anne Eva Bulstra, Yves Dudekem, Christian P Brizard, Robert G Weintraub, Benjamin R Loyer, Igor E KonstantinovAbstract:Background Children with body weight less than 2.5 kg who undergo the Arterial Switch Operation (ASO) represent a challenging group. We sought to determine outcomes of patients with weight less than 2.5 kg at ASO at a single institution. Methods All patients who underwent an ASO with biventricular repair and weighed less than 2.5 kg at time of surgery were identified from the hospital database and reviewed retrospectively. Results From 1983 to 2014, 870 patients underwent an ASO with biventricular repair at our institution. At the time of ASO, 31 patients (3.6%, 31 of 870) weighed less than 2.5 kg (mean 2.1; median 2.1; range, 1.1 to 2.4). Twenty-nine patients underwent an ASO for d-transposition of the great arteries, and 2 patients had an ASO for Taussig-Bing anomaly. Mean age at Operation was 16 days (median 11; range, 3 to 66). There were 6 hospital deaths (19%, 6 of 31) among patients weighing less than 2.5 kg compared with a hospital mortality of 1.9% (16 of 839) among patients weighing more than 2.5 kg ( p Conclusions Early mortality for children weighing less than 2.5 kg undergoing the ASO remains high; however, most of the mortality occurred in children weighing 2.0 kg or less. Long-term outcomes for survivors are excellent.
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excellent long term outcomes of the Arterial Switch Operation in patients with intramural coronary arteries
The Annals of Thoracic Surgery, 2016Co-Authors: Tyson A Fricke, Anne Eva Bulstra, Phillip S Naimo, Andrew Bullock, Terry Robertson, Yves Dudekem, Christian P Brizard, Igor E KonstantinovAbstract:Background Intramural coronary arteries may complicate coronary artery transfer during the Arterial Switch Operation. We sought to determine the long-term outcomes of 28 patients with intramural coronary arteries who underwent an Arterial Switch Operation at a single institution. Methods All patients who had intramural coronary arteries and underwent an Arterial Switch Operation were identified from the hospital database and retrospectively reviewed. Results From 1983 to 2009, 720 patients underwent an Arterial Switch Operation at our institution. Twenty-eight (3.9%, 28 of 720) had intramural coronary arteries. Patients with intramural coronary arteries had transposition of the great arteries (96%, n = 27) or Taussig-Bing anomaly (4%, n = 1). There were no deaths. Follow-up was 100% complete. Mean follow-up was 16.3 years (median, 15.5 years; range, 5.6 to 26.9 years). No patient required reOperation or catheter reintervention on the coronary arteries. Freedom from reOperation was 93% at 10 years. No patient had more than mild aortic regurgitation at last follow-up. Nine (32%, 9 of 28) patients had coronary angiograms at median 16 months (range, 14 months to 17 years) after Arterial Switch Operation. All patients were asymptomatic at the time of angiogram. One patient had mild stenosis of the circumflex coronary artery demonstrated on a routine coronary angiogram 14 months postoperatively. All 28 patients were asymptomatic and in New York Heart Association functional class I at last follow-up. Conclusions Patients with intramural coronary arteries are not at increased risk of death or coronary reinterventions and have excellent late outcomes after the Arterial Switch Operation.
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outcomes of the Arterial Switch Operation for transposition of the great arteries 25 years of experience
The Annals of Thoracic Surgery, 2012Co-Authors: Tyson A Fricke, Yves Dudekem, Gavin R Wheaton, Malcolm Richardson, Clarke A Thuys, Mithilesh Dronavalli, J Ramsay, Leeanne GriggAbstract:Background Studies on long-term outcomes of the Arterial Switch Operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO (p = 0.001), weight less than 2.5 kg at time of ASO (p Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.
Yves Dudekem - One of the best experts on this subject based on the ideXlab platform.
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outcomes of the Arterial Switch Operation in children less than 2 5 kilograms
The Annals of Thoracic Surgery, 2017Co-Authors: Tyson A Fricke, Anne Eva Bulstra, Yves Dudekem, Christian P Brizard, Robert G Weintraub, Benjamin R Loyer, Igor E KonstantinovAbstract:Background Children with body weight less than 2.5 kg who undergo the Arterial Switch Operation (ASO) represent a challenging group. We sought to determine outcomes of patients with weight less than 2.5 kg at ASO at a single institution. Methods All patients who underwent an ASO with biventricular repair and weighed less than 2.5 kg at time of surgery were identified from the hospital database and reviewed retrospectively. Results From 1983 to 2014, 870 patients underwent an ASO with biventricular repair at our institution. At the time of ASO, 31 patients (3.6%, 31 of 870) weighed less than 2.5 kg (mean 2.1; median 2.1; range, 1.1 to 2.4). Twenty-nine patients underwent an ASO for d-transposition of the great arteries, and 2 patients had an ASO for Taussig-Bing anomaly. Mean age at Operation was 16 days (median 11; range, 3 to 66). There were 6 hospital deaths (19%, 6 of 31) among patients weighing less than 2.5 kg compared with a hospital mortality of 1.9% (16 of 839) among patients weighing more than 2.5 kg ( p Conclusions Early mortality for children weighing less than 2.5 kg undergoing the ASO remains high; however, most of the mortality occurred in children weighing 2.0 kg or less. Long-term outcomes for survivors are excellent.
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excellent long term outcomes of the Arterial Switch Operation in patients with intramural coronary arteries
The Annals of Thoracic Surgery, 2016Co-Authors: Tyson A Fricke, Anne Eva Bulstra, Phillip S Naimo, Andrew Bullock, Terry Robertson, Yves Dudekem, Christian P Brizard, Igor E KonstantinovAbstract:Background Intramural coronary arteries may complicate coronary artery transfer during the Arterial Switch Operation. We sought to determine the long-term outcomes of 28 patients with intramural coronary arteries who underwent an Arterial Switch Operation at a single institution. Methods All patients who had intramural coronary arteries and underwent an Arterial Switch Operation were identified from the hospital database and retrospectively reviewed. Results From 1983 to 2009, 720 patients underwent an Arterial Switch Operation at our institution. Twenty-eight (3.9%, 28 of 720) had intramural coronary arteries. Patients with intramural coronary arteries had transposition of the great arteries (96%, n = 27) or Taussig-Bing anomaly (4%, n = 1). There were no deaths. Follow-up was 100% complete. Mean follow-up was 16.3 years (median, 15.5 years; range, 5.6 to 26.9 years). No patient required reOperation or catheter reintervention on the coronary arteries. Freedom from reOperation was 93% at 10 years. No patient had more than mild aortic regurgitation at last follow-up. Nine (32%, 9 of 28) patients had coronary angiograms at median 16 months (range, 14 months to 17 years) after Arterial Switch Operation. All patients were asymptomatic at the time of angiogram. One patient had mild stenosis of the circumflex coronary artery demonstrated on a routine coronary angiogram 14 months postoperatively. All 28 patients were asymptomatic and in New York Heart Association functional class I at last follow-up. Conclusions Patients with intramural coronary arteries are not at increased risk of death or coronary reinterventions and have excellent late outcomes after the Arterial Switch Operation.
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outcomes of the Arterial Switch Operation for transposition of the great arteries 25 years of experience
The Annals of Thoracic Surgery, 2012Co-Authors: Tyson A Fricke, Yves Dudekem, Gavin R Wheaton, Malcolm Richardson, Clarke A Thuys, Mithilesh Dronavalli, J Ramsay, Leeanne GriggAbstract:Background Studies on long-term outcomes of the Arterial Switch Operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO (p = 0.001), weight less than 2.5 kg at time of ASO (p Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.
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outcomes of the Arterial Switch Operation for transposition of the great arteries 25 years of experience
The Annals of Thoracic Surgery, 2012Co-Authors: Tyson A Fricke, Yves Dudekem, Malcolm Richardson, Clarke A Thuys, Mithilesh Dronavalli, J Ramsay, Gavin R WheatonAbstract:Background Studies on long-term outcomes of the Arterial Switch Operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO ( p = 0.001), weight less than 2.5 kg at time of ASO ( p p = 0.043), and the need for postoperative extracorporeal membrane oxygenation ( p p p p Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.
Kimberlee Gauvreau - One of the best experts on this subject based on the ideXlab platform.
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native bicuspid pulmonary valve in d loop transposition of the great arteries outcomes of the neo aortic valve function and root dilation after Arterial Switch Operation
Journal of the American Heart Association, 2021Co-Authors: Kimberlee Gauvreau, Elizabeth D Blume, Margaret Irwin, Geoffrey Binney, Sitaram M Emani, David W BrownAbstract:Background Neo‐aortic root dilation and neo‐aortic regurgitation (AR) are common after Arterial Switch Operation for D‐loop transposition of the great arteries. We sought to evaluate these outcomes...
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technical performance score s association with Arterial Switch Operation outcomes
The Annals of Thoracic Surgery, 2021Co-Authors: Angelika Muter, Pedro J Del Nido, Kimberlee Gauvreau, Steven D Colan, Jane W Newburger, Haley M EvansAbstract:Background Outcomes after the Arterial Switch Operation (ASO) for dextro-transposition of the great arteries have improved significantly since its inception in the 1980s. This study reviews contemporaneous outcomes and predictors for late reinterventions after ASO. Methods We retrospectively reviewed patients who underwent ASO for dextro-transposition of the great arteries from 1997 to 2017. Technical performance score (TPS) class (class 1, trivial or no residua; class 2, minor residua; class 3, major residua or reintervention) was assigned at discharge based on echocardiographic evaluation of components of the ASO. Multivariable Cox regression identified patient- and procedure-specific factors associated with postdischarge reinterventions. Results Among 598 patients, 410 (69%) underwent ASO and 188 (31%) underwent ASO with ventricular septal defect repair. Median age at surgery was 5 days (interquartile range, 3 to 7); median follow-up time was 8.2 years; 408 (68%) were male; 50 (8.3%) were premature; and 10 (1.7%) had noncardiac anomalies or syndromes. Survival to hospital discharge was 98% (n = 591). Among 349 patients with follow-up, freedom from unplanned reintervent2ion at 5 years was 99% for TPS class 1, compared with 84% for class 2 and 30% for class 3. On multivariable Cox regression, classes 2 and 3 had significantly higher hazard for reintervention (class 2 hazard ratio 10.6; 95% confidence interval, 2.5 to 44.2; P = .001; class 3 hazard ratio 58.2, 95% confidence interval, 13.1 to 259; P Conclusions At our center, ASO was associated with relatively low mortality. Class 2 and class 3 TPS were the most important independent predictors of reinterventions after discharge. Therefore, TPS can serve as a tool for identifying high-risk patients who warrant closer follow-up.
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long term predictors of aortic root dilation and aortic regurgitation after Arterial Switch Operation
Circulation, 2004Co-Authors: Marcy L Schwartz, Pedro J Del Nido, Kimberlee Gauvreau, John E Mayer, Steven D ColanAbstract:Background— Neo-aortic root dilation (ARD) and neo-aortic regurgitation (AR) may be progressive after Arterial Switch Operation (ASO) for d-loop transposition of the great arteries (dTGA). We sought to identify predictors of ARD and AR after ASO. Methods and Results— 335 patients were identified who underwent ASO for dTGA with intact ventricular septum or ventricular septal defect (VSD), including double-outlet right ventricle (DORV), before 2001 with at least 1 postoperative echocardiogram at our institution, at least 1 year after ASO, and no previous atrial Switch procedure (median follow-up of 5.0 years). Probability of freedom from ARD was 97%, 92%, 82%, and 51%, from at least moderate AR was 98%, 97%, 96%, and 93%, and from neo-aortic valve or root surgery was 100%, 100%, 99%, and 95%, at 1, 2, 5, and 10 years, respectively. For patients in whom ARD developed, progressive dilation was not observed during late follow-up. By Kaplan–Meier method, independent predictors of ARD, with neo-aortic root z-sco...
Gil Wernovsky - One of the best experts on this subject based on the ideXlab platform.
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Rapid Two-Stage Arterial Switch Operation Acquisition of Left Ventricular Mass After Pulmonary Artery Banding in Infants With Transposition of the Great Arteries
2015Co-Authors: Gil Wernovsky, C Boutin, R A Jonas, S M Mone, S D Colan, Bs Steven, D. ColanAbstract:pulmonary artery banding in infants with transposition of the great arteries. Rapid two-stage Arterial Switch Operation. Acquisition of left ventricular mass afte
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coronary artery pattern and age impact exercise performance late after the Arterial Switch Operation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Sara K Pasquali, Gil Wernovsky, Bradley S Marino, Michael G Mcbride, Stephen M ParidonAbstract:Objective The impact of coronary artery pattern on exercise performance after the Arterial Switch Operation is unknown. The purpose of this study was to evaluate the relationship between coronary artery pattern and exercise performance late after the Arterial Switch Operation. Methods Patients who underwent the Arterial Switch Operation and were referred for exercise stress testing between January of 1996 and April of 2005 were included. Univariate and multivariate analyses were performed to identify risk factors for lower maximum heart rate and percent of predicted peak oxygen consumption. Results Fifty-three patients were included; 72% were male. The median age at the Arterial Switch Operation was 5 days (1 day to 3.6 years); 32% had concurrent ventricular septal defect repair. The time from the Arterial Switch Operation to exercise stress testing was 14.1 years (7.7–20.6 years). There were 37 patients with the usual coronary artery pattern, and 16 patients (30%) with variant coronary artery patterns. At exercise stress testing, there was no difference in respiratory exchange ratio (1.16 ± 0.1 for both), indicating similar effort. Compared with patients with the usual coronary artery pattern, patients with variant coronary artery patterns had a significantly lower maximum heart rate (177 ± 16 beats/min [89% predicted] vs 186 ± 11 beats/min [93% predicted], respectively, P = .04). Percent of predicted peak oxygen consumption was not significantly different between patients with the usual coronary pattern and patients with variant coronary artery patterns (89% ± 20% vs 80% ± 17%, respectively, P = .12). In multivariate analysis, variant coronary artery patterns ( P = .03) and ventricular septal defect ( P = .004) were predictors of significantly lower maximum heart rate and were associated with a trend toward lower percent of predicted peak oxygen consumption ( P P Conclusions Variant coronary artery patterns are associated with chronotropic impairment, and longer follow-up time is the strongest predictor of diminished aerobic capacity late after Arterial Switch Operation.
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coronary artery abnormalities detected at cardiac catheterization following the Arterial Switch Operation for transposition of the great arteries
American Journal of Cardiology, 1995Co-Authors: Ronn E Tanel, Gil Wernovsky, Michael J Landzberg, Stanton B Perry, Redmond P BurkeAbstract:Abstract Because the Arterial Switch Operation has become the routine surgical approach for transposition of the great arteries, there is increasing awareness of adverse sequelae in some survivors. For the Arterial Switch to be considered the procedure of choice for transposition of the great arteries, long-term patency and normal function of the translocated coronary arteries must be achieved. We reviewed the cineangiograms and hemodynamic data in 366 patients who underwent postoperative atheterization after Arterial Switch Operation. Of these, 13 patients (3%) had previously unsuspected coronary abnormalities diagnosed angiographically. No patient had noninvasive evidence of resting systolic dysfunction. Findings included left main coronary artery stenosis (n = 3) or occlusion (n = 2), anterior descending coronary artery stenosis (n = 1) or occlusion (n = 2), right coronary artery stenosis (n = 1) or occlusion (n = 1), and small coronary artery fistulas (n = 3). One patient died suddenly 3.3 years after surgery, 1 patient is lost to follow-up, and the remaining 10 patients are alive and asymptomatic up to 11 years after surgery.
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factors influencing early and late outcome of the Arterial Switch Operation for transposition of the great arteries
The Journal of Thoracic and Cardiovascular Surgery, 1995Co-Authors: Gil Wernovsky, John E Mayer, R A Jonas, Frank L Hanley, Eugene H Blackstone, John W Kirklin, Aldo R CastanedaAbstract:Abstract Between January 1983 and January 1992, 470 patients underwent an Arterial Switch Operation at our institution. An intact (or virtually intact) ventricular septum was present in 278 of 470 (59%); a ventricular septal defect was closed in the remaining 192. Survivals at 1 month and 1, 5, and 8 years among the 470 patients were 93%, 92%, 91%, and 91%, respectively. The hazard function for death (at any time) had a rapidly declining single phase that approached zero by one year after the Operation. Risk factors for death included coronary artery patterns with a retropulmonary course of the left coronary artery (two types) and a pattern in which the right coronary artery and left anterior descending arose from the anterior sinus with a posterior course of the circumflex coronary. The only procedural risk factor identified was augmentation of the aortic arch; longer duration of circulatory arrest was also a risk factor for death. Earlier date of Operation was a risk factor for death, but only in the case of the senior surgeon. Reinterventions were performed to relieve right ventricular and/or pulmonary artery stenoses alone in 28 patients. The hazard function for reintervention for pulmonary artery or valve stenosis revealed an early phase that peaked at 9 months after the Operation and a constant phase for the duration of follow-up. Incremental risk factors for the early phase included multiple ventricular septal defects, the rapid two-stage Arterial Switch, and a coronary pattern with a single ostium supplying the right coronary and left anterior descending, with a retropulmonary course of the circumflex. The need for reintervention has decreased with time. The Arterial Switch Operation can currently be performed early in life with a low mortality risk (
Gavin R Wheaton - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes of the Arterial Switch Operation
The Journal of Thoracic and Cardiovascular Surgery, 2021Co-Authors: Tyson A Fricke, Andrew Bullock, Edward Buratto, Robert G Weintraub, Gavin R Wheaton, Leeanne Grigg, Patrick DisneyAbstract:Abstract Objectives The Arterial Switch Operation (ASO) has excellent early outcomes in the modern era. We sought to determine the long-term outcomes in patients who underwent an ASO at a single institution. Methods Patients who underwent an ASO between 1983 and 2015 were identified from the hospital database and retrospectively reviewed using hospital records. Results From 1983 to 2015, 844 patients with a biventricular circulation underwent an ASO. There were 28 (3.3%, 28/844) early deaths. Follow-up was available for 94% (729/774) of local patients after hospital discharge. Median follow-up was 15 years (interquartile range, 8-20 years). There were 187 (26%, 187/729) patients with more than 20 years of follow-up and 95 (13%, 95/729) patients with more than 25 years of follow-up. Overall survival was 95% (95% confidence interval [CI], 94%-97%) at 10 and 25 years after the ASO. At 25 years after ASO, freedom from overall reintervention was 77% (95% CI, 73%-81%), freedom from reOperation on the neoaortic root or neoaortic valve was 92% (95% CI, 88%-95%), and freedom from coronary reOperation was 99% (95% CI, 98%-99.7%). Left ventricular (LV) systolic function was normal in 595 of 609 (98%) of patients who had LV function quantified at latest follow-up. Of the 95 patients with more than 25 years of follow-up after ASO, 6 (6.3%) had at least moderate neoaortic valve regurgitation (AR) and 8 (8.4%) had undergone replacement of the neoaortic valve. Conclusions Overall, survivors of ASO have excellent late survival and normal LV systolic function into adult life. However, AR and reOperation on the neoaortic valve remains an issue for older patients.
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outcomes of the Arterial Switch Operation for transposition of the great arteries 25 years of experience
The Annals of Thoracic Surgery, 2012Co-Authors: Tyson A Fricke, Yves Dudekem, Gavin R Wheaton, Malcolm Richardson, Clarke A Thuys, Mithilesh Dronavalli, J Ramsay, Leeanne GriggAbstract:Background Studies on long-term outcomes of the Arterial Switch Operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO (p = 0.001), weight less than 2.5 kg at time of ASO (p Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.
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outcomes of the Arterial Switch Operation for transposition of the great arteries 25 years of experience
The Annals of Thoracic Surgery, 2012Co-Authors: Tyson A Fricke, Yves Dudekem, Malcolm Richardson, Clarke A Thuys, Mithilesh Dronavalli, J Ramsay, Gavin R WheatonAbstract:Background Studies on long-term outcomes of the Arterial Switch Operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO ( p = 0.001), weight less than 2.5 kg at time of ASO ( p p = 0.043), and the need for postoperative extracorporeal membrane oxygenation ( p p p p Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.