Atrial to arterial repair of transposition: The importance of the switch

During the past 40 years, the outlook for a newborn with complete transposition has improved remarkably. Atrial repair improved survival from less than 10% 1 year after birth to greater than 80% to age 20 years. The excellent long-term survival and low risk of the atrial repair created an ethical dilemma in making the decision to abandon atrial repair in favor of the unknown risks and benefits of the arterial switch operation. In our institution, the leadership of Dr. Robert M. Freedom was instrumental in promoting that change. The success of the arterial switch operation in managing the neonate with transposition led to a much wider application of neonatal and infant intracardiac repair for other congenital heart lesions. In the current era, neonates with complete transposition have outcomes approaching those of a normal child.