Arterial Switch Procedure

What is an arterial switch procedure?

An arterial switch procedure is a rare operation to move your baby’s aorta and pulmonary artery to their typical places. A surgeon attaches your baby’s aorta to their left ventricle (lower heart chamber). Then, the surgeon attaches your baby’s pulmonary artery to their right ventricle. Surgeons perform this open-heart surgery during the first two weeks after your baby’s birth.

What does an arterial switch procedure treat?

An arterial switch procedure corrects d-transposition of the great arteries (D-TGA). This is a congenital (present at birth) condition where two large arteries leaving your baby’s heart are in the wrong places. The surgery improves oxygen levels in your baby and helps their heart work better.

When blood goes to the right places, it can get oxygen from your baby’s lungs and distribute it to their body. This operation makes that possible, giving your baby a strong chance to grow into an adult.

What happens before an arterial switch procedure?

Soon after your baby’s birth, a provider will use other therapies to help your baby get more oxygen before surgery. Providers can offer:

• Septostomy (a temporary procedure to improve oxygen flow).
• Breathing assistance with a ventilator.
• Medications like inotropes or prostaglandin.

To prepare for surgery, a provider may use an echocardiogram to look at the size and function of parts of your baby’s heart. They may also take a chest X-ray or electrocardiogram (EKG). These noninvasive tests are painless.

What happens during an arterial switch procedure?

During an arterial switch procedure, a cardiothoracic surgeon will:

1. Open your baby’s chest with a sternotomy.
2. Start cardiopulmonary bypass.
3. Disconnect your baby’s aorta and pulmonary artery without involving their nearby heart valves.
4. Remove the coronary arteries from the native aorta that links to the right ventricle (the wrong place) in babies with d-TGA.
5. Attach the coronary arteries to what will be your baby’s “new” aorta.
6. Reconnect your baby’s aorta to their left ventricle, which typically pumps oxygen-rich blood to their body.
7. Reconnect your baby’s pulmonary artery to their right ventricle, which typically carries oxygen-poor blood to their lungs for oxygen.
8. Close your baby’s chest.

If your baby has an atrial septal defect (hole between heart chambers), a surgeon will close it during this surgery.

How long is an arterial switch operation?

An arterial switch procedure takes many hours. You can expect your baby to be in the operating room for at least half of a standard workday.

What happens after an arterial switch procedure?

After surgery, your baby will likely spend time in an intensive care unit. You can expect to see tubes, wires and machines attached to your child. While this may be difficult to see, it’s helpful to remember that each piece of equipment has a role in helping your baby get better.

What are the benefits of an arterial switch procedure?

The arterial switch procedure is a lifesaving operation. It allows oxygen from your baby’s lungs to get into their blood and to their whole body. Without surgery, 50% of babies with d-TGA won’t survive the first month after birth.

What is the success rate of the arterial switch?

Long-term results are excellent after an arterial switch procedure. It has a mortality rate (risk of death) below 2%. Risks may be higher for more complex cases.

Healthcare providers have reported that about 96% of people who had an arterial switch procedure were alive 25 years later. Most children who have this surgery don’t need to limit their physical activity over time.

What are the risks or complications of an arterial switch procedure?

Complications, which may happen a year later or more, may include:

• Blockages in coronary arteries or the right ventricular outflow tract.
• Widening or narrowing of relocated vessels.
• Leaky heart valves.

Your child may need another surgery later to fix these issues. They also may need other types of care for problems like depression, anxiety and difficulty with cognitive skills like memory and attention. These tend to happen in babies who start life with a low oxygen level. Knowing this in advance can help you prepare to watch for problems and arrange for the help your child needs.

What is the recovery time?

Arterial switch procedure recovery time starts in the hospital with a two-week stay. Recovery will continue at home with instructions about caring for your baby’s incision and giving them the medicines they need.

Follow-up appointments

A week or two after going home, your baby will have a checkup with their surgeon. They’ll also need a visit with their pediatric cardiologist in those first few weeks at home.

Your child will need regular checkups each year with a provider throughout their lifetime. This allows their provider to catch any issues before they worsen. They may do noninvasive tests every two years or so to make sure your child’s oxygen level is good.

When should I call my healthcare provider?

After surgery, contact your surgical team if your child has redness, swelling or fluid around their wound or a fever.

A note from Cleveland Clinic

Watching your newborn struggle for oxygen may be one of the hardest things you do as a parent. But being a good parent means doing what’s best for your child. So, even if it’s scary to think about heart surgery, know that experts agree it’s the right treatment for your baby. Your role is to have a basic understanding of the procedure, so don’t be afraid to ask questions about it. Also, ask your baby’s care team how you can provide comfort to your newborn safely while they recover.