Arterial switch operation under an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease: A single-center retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Zirui ^1,2 , LING Jing ^1,3 , WU Jiaxiong ^2,3 , LIANG Runzhang ^2,3 , WANG Canxin ^2,3 , LI Jinxin ^2,3 , YUAN Haiyun ^1,2 ,  WEN Shusheng ^1,2

1. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;
3. Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;

Corresponding?author：

WEN Shusheng, Email: wenshusheng@gdph.org.cn

Keywords：

Arterial switch operation; complete transposition of the great arteries; Taussig-Bing anomaly; congenital heart disease; integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease

DOI：

10.7507/1007-4848.202507085

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Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.

Citation： PENG Zirui, LING Jing, WU Jiaxiong, LIANG Runzhang, WANG Canxin, LI Jinxin, YUAN Haiyun, WEN Shusheng. Arterial switch operation under an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease: A single-center retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(3): 415-423. doi: 10.7507/1007-4848.202507085 Copy

1.	Fricke TA, Konstantinov IE. Arterial switch operation: operative approach and outcomes. Ann Thorac Surg, 2019, 107(1): 302-310.
2.	Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
3.	Nguyen SN, Vinogradsky AV, Tao AM, et al. Rare coronary artery variants are associated with increased mortality and reinterventions following the arterial switch operation. J Thorac Cardiovasc Surg, 2025, 169(1): 217-228. e222.
4.	Cattapan C, Jacobs JP, Bleiweis MS, et al. Outcomes of neonatal cardiac surgery: a European Congenital Heart Surgeons Association study. Ann Thorac Surg, 2025, 119(4): 880-889.
5.	Santens B, Van De Bruaene A, De Meester P, et al. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol, 2020, 316: 94-100.
6.	曲艷吉, 羅丹東, 劉小清, 等. 大動脈調轉術: 單中心20年571例患者結果的雙向隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(2): 133-141.Qu YJ, Luo DD, Liu XQ, et al. Arterial switch operation: a bidirectional cohort study of 571 patients over 20 years at a single center. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(2): 133-141.
7.	譚玉玉, 潘微, 龐程程, 等. 完全性大動脈轉位患兒300例動脈調轉術后結果及隨訪分析. 中華實用兒科臨床雜志, 2022, 37(7): 521-525.Tan YY, Pan W, Pang CC, et al. Outcomes and follow-up analysis after arterial switch operation in 300 children with complete transposition of the great arteries. Chin J Pract Pediatr, 2022, 37(7): 521-525.
8.	Fricke TA, Buratto E, Weintraub RG, et al. Long-term outcomes of the arterial switch operation. J Thorac Cardiovasc Surg, 2022, 163(1): 212-219.
9.	GBD 2017 Congenital Heart Disease Collaborators. Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health, 2020, 4(3): 185-200.
10.	Zhang Y, Wang J, Zhao J, et al. Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China. Lancet Child Adolesc Health, 2023, 7(7): 479-489.
11.	He Y, Xu W, Su Z, et al. Addressing the rising burden of congenital heart disease in China. Lancet Child Adolesc Health, 2020, 4(4): e7.
12.	Holland BJ, Myers JA, Woods CR Jr. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol, 2015, 45(6): 631-638.
13.	Kunde F, Thomas S, Sudhakar A, et al. Prenatal diagnosis and planned peripartum care improve perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum in low-resource settings. Ultrasound Obstet Gynecol, 2021, 58(3): 398-404.
14.	Lin X, Huang Y, Xie W, et al. Integrated prenatal and postnatal management for neonates with transposition of the great arteries: thirteen-year experience at a single center. Ital J Pediatr, 2024, 50(1): 153.
15.	Hayes DA, Jones S, Quaegebeur JM, et al. Primary arterial switch operation as a strategy for total correction of Taussig-Bing anomaly: a 21-year experience. Circulation, 2013, 128(11 Suppl 1): S194-S198.
16.	Angeli E, Raisky O, Bonnet D, et al. Late reoperations after neonatal arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg, 2008, 34(1): 32-36.
17.	Michalak KW, Moll JA, Sobczak-Budlewska K, et al. Reoperations and catheter interventions in patients with transposition of the great arteries after the arterial switch operation. Eur J Cardiothorac Surg, 2017, 51(1): 34-42.
18.	van der Palen RLF, Blom NA, Kuipers IM, et al. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg, 2021, 59(5): 968-977.
19.	Schlein J, Ungerb?ck C, Tertschnig D, et al. Long-term outcomes after arterial switch operation for dextro-transposition of the great arteries-30-year single-center experience. J Clin Med, 2025, 14(9): 3160.
20.	Seripanu P, Srisuwan T, Pongprot Y, et al. Association of pulmonary artery bifurcation angle shift with contralateral stenosis after post-arterial switch in the pediatric transposition of great artery patients. PLoS One, 2025, 20(6): e0325206.
21.	Rocha RV, Barron DJ, Mazine A, et al. Evolving concern: late outcomes after repair of transposition of the great arteries. J Thorac Cardiovasc Surg, 2025, 169(5): 1296-1303. e1292.
22.	Thrupp SF, Gentles TL, Kerr AR, et al. Arterial switch operation: early and late outcome for intramural coronary arteries. Ann Thorac Surg, 2012, 94(6): 2084-2090.
23.	Possner M, Buechel RR, Vontobel J, et al. Myocardial blood flow and cardiac sympathetic innervation in young adults late after arterial switch operation for transposition of the great arteries. Int J Cardiol, 2020, 299: 110-115.
24.	Vida VL, Zanotto L, Zanotto L, et al. Left-sided reoperations after arterial switch operation: a European multicenter study. Ann Thorac Surg, 2017, 104(3): 899-906.
25.	Amancherla K, Menachem JN, Shah AS, et al. Limited balloon atrial septostomy for left ventricular unloading in peripheral extracorporeal membrane oxygenation. J Card Fail, 2021, 27(4): 501-504.
26.	Cirstoveanu C, Georgescu C, Bizubac M, et al. Impact of bedside balloon atrial septostomy in neonates with transposition of the great arteries in a neonatal intensive care unit in Romania. Life (Basel), 2023, 13(4): 997.
27.	Anderson BR, Ciarleglio AJ, Hayes DA, et al. Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. J Am Coll Cardiol, 2014, 63(5): 481-487.
28.	Hamzah M, Othman HF, Peluso AM, et al. Prevalence and outcomes of balloon atrial septostomy in neonates with transposition of great arteries. Pediatr Crit Care Med, 2020, 21(4): 324-331.
29.	O'Byrne ML, Glatz AC, Song L, et al. Association between variation in preoperative care before arterial switch operation and outcomes in patients with transposition of the great arteries. Circulation, 2018, 138(19): 2119-2129.
30.	Ali SKM, Elsheikh A, Alhassan MA, et al. Immediate and intermediate-term outcomes of infants with transposition of great arteries who underwent balloon atrial septostomy in Sudan. Glob Heart, 2025, 20(1): 5.

1. Fricke TA, Konstantinov IE. Arterial switch operation: operative approach and outcomes. Ann Thorac Surg, 2019, 107(1): 302-310.
2. Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
3. Nguyen SN, Vinogradsky AV, Tao AM, et al. Rare coronary artery variants are associated with increased mortality and reinterventions following the arterial switch operation. J Thorac Cardiovasc Surg, 2025, 169(1): 217-228. e222.
4. Cattapan C, Jacobs JP, Bleiweis MS, et al. Outcomes of neonatal cardiac surgery: a European Congenital Heart Surgeons Association study. Ann Thorac Surg, 2025, 119(4): 880-889.
5. Santens B, Van De Bruaene A, De Meester P, et al. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol, 2020, 316: 94-100.
6. 曲艷吉, 羅丹東, 劉小清, 等. 大動脈調轉術: 單中心20年571例患者結果的雙向隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(2): 133-141.Qu YJ, Luo DD, Liu XQ, et al. Arterial switch operation: a bidirectional cohort study of 571 patients over 20 years at a single center. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(2): 133-141.
7. 譚玉玉, 潘微, 龐程程, 等. 完全性大動脈轉位患兒300例動脈調轉術后結果及隨訪分析. 中華實用兒科臨床雜志, 2022, 37(7): 521-525.Tan YY, Pan W, Pang CC, et al. Outcomes and follow-up analysis after arterial switch operation in 300 children with complete transposition of the great arteries. Chin J Pract Pediatr, 2022, 37(7): 521-525.
8. Fricke TA, Buratto E, Weintraub RG, et al. Long-term outcomes of the arterial switch operation. J Thorac Cardiovasc Surg, 2022, 163(1): 212-219.
9. GBD 2017 Congenital Heart Disease Collaborators. Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health, 2020, 4(3): 185-200.
10. Zhang Y, Wang J, Zhao J, et al. Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China. Lancet Child Adolesc Health, 2023, 7(7): 479-489.
11. He Y, Xu W, Su Z, et al. Addressing the rising burden of congenital heart disease in China. Lancet Child Adolesc Health, 2020, 4(4): e7.
12. Holland BJ, Myers JA, Woods CR Jr. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol, 2015, 45(6): 631-638.
13. Kunde F, Thomas S, Sudhakar A, et al. Prenatal diagnosis and planned peripartum care improve perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum in low-resource settings. Ultrasound Obstet Gynecol, 2021, 58(3): 398-404.
14. Lin X, Huang Y, Xie W, et al. Integrated prenatal and postnatal management for neonates with transposition of the great arteries: thirteen-year experience at a single center. Ital J Pediatr, 2024, 50(1): 153.
15. Hayes DA, Jones S, Quaegebeur JM, et al. Primary arterial switch operation as a strategy for total correction of Taussig-Bing anomaly: a 21-year experience. Circulation, 2013, 128(11 Suppl 1): S194-S198.
16. Angeli E, Raisky O, Bonnet D, et al. Late reoperations after neonatal arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg, 2008, 34(1): 32-36.
17. Michalak KW, Moll JA, Sobczak-Budlewska K, et al. Reoperations and catheter interventions in patients with transposition of the great arteries after the arterial switch operation. Eur J Cardiothorac Surg, 2017, 51(1): 34-42.
18. van der Palen RLF, Blom NA, Kuipers IM, et al. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg, 2021, 59(5): 968-977.
19. Schlein J, Ungerb?ck C, Tertschnig D, et al. Long-term outcomes after arterial switch operation for dextro-transposition of the great arteries-30-year single-center experience. J Clin Med, 2025, 14(9): 3160.
20. Seripanu P, Srisuwan T, Pongprot Y, et al. Association of pulmonary artery bifurcation angle shift with contralateral stenosis after post-arterial switch in the pediatric transposition of great artery patients. PLoS One, 2025, 20(6): e0325206.
21. Rocha RV, Barron DJ, Mazine A, et al. Evolving concern: late outcomes after repair of transposition of the great arteries. J Thorac Cardiovasc Surg, 2025, 169(5): 1296-1303. e1292.
22. Thrupp SF, Gentles TL, Kerr AR, et al. Arterial switch operation: early and late outcome for intramural coronary arteries. Ann Thorac Surg, 2012, 94(6): 2084-2090.
23. Possner M, Buechel RR, Vontobel J, et al. Myocardial blood flow and cardiac sympathetic innervation in young adults late after arterial switch operation for transposition of the great arteries. Int J Cardiol, 2020, 299: 110-115.
24. Vida VL, Zanotto L, Zanotto L, et al. Left-sided reoperations after arterial switch operation: a European multicenter study. Ann Thorac Surg, 2017, 104(3): 899-906.
25. Amancherla K, Menachem JN, Shah AS, et al. Limited balloon atrial septostomy for left ventricular unloading in peripheral extracorporeal membrane oxygenation. J Card Fail, 2021, 27(4): 501-504.
26. Cirstoveanu C, Georgescu C, Bizubac M, et al. Impact of bedside balloon atrial septostomy in neonates with transposition of the great arteries in a neonatal intensive care unit in Romania. Life (Basel), 2023, 13(4): 997.
27. Anderson BR, Ciarleglio AJ, Hayes DA, et al. Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. J Am Coll Cardiol, 2014, 63(5): 481-487.
28. Hamzah M, Othman HF, Peluso AM, et al. Prevalence and outcomes of balloon atrial septostomy in neonates with transposition of great arteries. Pediatr Crit Care Med, 2020, 21(4): 324-331.
29. O'Byrne ML, Glatz AC, Song L, et al. Association between variation in preoperative care before arterial switch operation and outcomes in patients with transposition of the great arteries. Circulation, 2018, 138(19): 2119-2129.
30. Ali SKM, Elsheikh A, Alhassan MA, et al. Immediate and intermediate-term outcomes of infants with transposition of great arteries who underwent balloon atrial septostomy in Sudan. Glob Heart, 2025, 20(1): 5.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Arterial switch operation under an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease: A single-center retrospective cohort study

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