Arterial Switch Procedure: Surgery, Recovery and Outlook for Babies With TGA
Updated: 3 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer: What is an arterial switch procedure?
An arterial switch procedure is open-heart surgery for newborns with D-transposition of the great arteries (D-TGA), a heart defect in which the two main arteries leaving the heart are swapped. It's done in the first two weeks of life, carries a risk of death below 2% and about 96% of patients are alive 25 years later. [1]
What the research says
Serious problems with the new aortic valve are uncommon after the switch. Across 80 studies, moderate-to-severe leaking of the aortic valve was found in 2.89% of 20,338 patients, and 2.71% of 11,291 patients needed another procedure on the new aorta; a ventricular septal defect, earlier pulmonary artery banding and a size mismatch between the great arteries raised the risk. (Negm et al., Archives of Cardiovascular Diseases, 2026) [2]
Most children score in the normal range for thinking skills by age 5. In 17 studies of 809 children who had corrective surgery as newborns, average IQ scores at ages 4 to 5 did not differ from the general population, though more toddlers than expected scored below average on motor and language tests at ages 1 to 3. (Soares et al., Cardiology in the Young, 2023) [3]
Key takeaways
The arterial switch corrects D-TGA, a condition present at birth in which the aorta and pulmonary artery are in the wrong places. [1]
Without treatment, 50% of babies with D-TGA do not survive the first month of life. [1]
Surgery is done in the first two weeks after birth, using a heart-lung machine. [1]
The first hospital stay is usually about two weeks. [1]
Long-term results are excellent, but your child needs yearly heart checkups for life. [1]
Why is an arterial switch procedure needed?
In a healthy heart, the aorta carries oxygen-rich blood from the left ventricle to the body, and the pulmonary artery carries oxygen-poor blood from the right ventricle to the lungs. In D-transposition of the great arteries, these two arteries are switched. As a result, oxygen from the lungs cannot reach the rest of the body properly. [1]
The arterial switch moves the arteries to their correct positions. The goals are to raise your baby's oxygen levels, help the heart work better and let oxygen from the lungs reach the whole body. [1]
What the arterial switch procedure corrects.
How do you prepare for an arterial switch procedure?
Before surgery, your baby may need treatments that raise oxygen levels, such as: [1]
Septostomy, a temporary procedure that improves oxygen flow
A ventilator to help with breathing
Medicines such as prostaglandin or inotropes
Your baby will also have painless tests to look at the heart, including an echocardiogram, a chest X-ray and an electrocardiogram (EKG). [1]
What happens during an arterial switch procedure?
A cardiothoracic surgeon performs the operation. The main steps are: [1]
Opening the chest through the breastbone (sternotomy).
Starting the heart-lung machine (cardiopulmonary bypass).
Disconnecting the aorta and pulmonary artery without involving the nearby heart valves.
Removing the coronary arteries from the aorta in the wrong place.
Attaching the coronary arteries to the new aorta.
Connecting the aorta to the left ventricle, which pumps oxygen-rich blood to the body.
Connecting the pulmonary artery to the right ventricle, which sends oxygen-poor blood to the lungs.
Closing the chest.
If your baby also has an atrial septal defect (a hole between the upper heart chambers), the surgeon closes it during the same operation. The surgery takes many hours, and your baby is in the operating room for at least half of a standard workday. [1]
The main steps of the arterial switch procedure.
Arterial switch procedure at a glance
Item | Typical detail |
Age at surgery | First two weeks of life |
Condition treated | D-transposition of the great arteries (D-TGA) |
Type of surgery | Open-heart surgery with a heart-lung machine |
Time in surgery | Many hours, at least half a workday |
First hospital stay | About two weeks, including intensive care |
Sources: [1]
What is recovery like after an arterial switch?
After surgery, your baby will likely spend time in the intensive care unit, connected to tubes, wires and machines. The first hospital stay is usually about two weeks. [1]
At home, you will care for the incision and give any prescribed medicines. Follow-up usually includes: [1]
A visit with the surgeon one to two weeks after going home
A visit with a pediatric cardiologist in the first few weeks at home
Yearly checkups for life
Noninvasive tests about every two years to check oxygen levels
When to call your baby's care team
Contact the surgical team if your baby has: [1]
Redness or swelling around the wound
Fluid coming from the wound
A fever
What are the risks of an arterial switch?
The risk of death from the operation is below 2%, though it may be higher in more complex cases. Some complications can appear a year or more after surgery, and another surgery may be needed later. [1]
Possible problem | What it means |
Coronary artery blockage | The moved coronary arteries narrow or block |
Outflow blockage | A narrowing where blood leaves the right ventricle |
Changes in the moved vessels | The relocated arteries widen or narrow |
Leaky heart valves | A valve does not close fully, so blood leaks back |
Sources: [1]
Children who start life with low oxygen levels are more likely to need extra support later for depression, anxiety or problems with memory and attention. [1]
What is the outlook after an arterial switch procedure?
Average survival and outlook after the arterial switch.
The arterial switch is a lifesaving operation. Without treatment, 50% of babies with D-TGA do not survive their first month. After surgery, about 96% of patients are alive 25 years later, and most children do not need to limit physical activity as they grow. [1]
Long-term results are excellent. Lifelong checkups help your child's team catch problems early. [1]
Conclusion
The arterial switch procedure fixes a life-threatening heart defect by moving the two great arteries, and the coronary arteries, back where they belong. Done in the first two weeks of life, it gives most babies a long, active life.
Recovery starts with about two weeks in the hospital, followed by lifelong heart checkups. Keeping every follow-up visit is the best way to spot rare late problems early.
Keep learning: Read our guide to transposition of the great arteries, or learn more about cyanotic heart disease.
FAQ
What is an arterial switch procedure?
It is open-heart surgery that moves a newborn's aorta and pulmonary artery to their correct positions and reattaches the coronary arteries to the new aorta.
What condition does the arterial switch treat?
It treats D-transposition of the great arteries (D-TGA), where the two main arteries leaving the heart are in the wrong places.
When is the arterial switch procedure done?
It is done during the first two weeks after birth.
How long does the arterial switch surgery take?
The surgery takes many hours, and the baby is in the operating room for at least half of a standard workday.
How long will my baby stay in the hospital?
The first hospital stay is usually about two weeks, including time in intensive care.
What is the success rate of the arterial switch procedure?
The risk of death from the operation is below 2%, and about 96% of patients are alive 25 years later.
What happens without an arterial switch?
Without treatment, 50% of babies with D-TGA do not survive the first month of life.
What are the long-term risks after an arterial switch?
Later problems can include coronary artery blockages, narrowing or widening of the moved vessels and leaky heart valves.
Will my child need more surgery later?
Some children need another surgery later, which is why lifelong yearly checkups are important.
Can my child be active after an arterial switch?
Yes. Most children do not need to limit physical activity over time.
How do I prepare for my baby's arterial switch procedure?
Before surgery, your baby may need treatments that raise oxygen levels, such as a septostomy, a ventilator or medicines like prostaglandin. Your baby will also have painless heart tests, including an echocardiogram, a chest X-ray and an EKG [1].
When should I call the doctor after an arterial switch?
Contact your baby's surgical team if you notice redness or swelling around the wound, fluid coming from the wound, or a fever [1].
Does the arterial switch procedure hurt my baby?
Open-heart surgery in children is done while the child is under general anesthesia, so the child is asleep and pain free during the operation. [4]
Related Reading
Transposition of the Great Arteries (TGA): Symptoms, Causes, and Treatment in the First Days of Life
References
Cleveland Clinic. Arterial Switch Procedure. Cleveland Clinic. Last updated August 8, 2024. https://my.clevelandclinic.org/health/procedures/arterial-switch-procedure
Negm S, Mahmoud AB, Desnous B, et al. Neoaortic outcomes after the arterial switch operation: a systematic review and meta-analysis. Arch Cardiovasc Dis. 2026;119(3):233-243. PMID 41193284. https://doi.org/10.1016/j.acvd.2025.08.013
Soares C, Vieira RJ, Costa S, et al. Neurodevelopment outcomes in the first 5 years of the life of children with transposition of the great arteries surgically corrected in the neonatal period: systematic review and meta-analysis. Cardiol Young. 2023;33(12):2471-2480. PMID 37965690. https://doi.org/10.1017/S104795112300375X
MedlinePlus. Pediatric heart surgery. MedlinePlus. Last reviewed January 17, 2025. https://medlineplus.gov/ency/article/007363.htm
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own situation before making decisions about your health. If you think you have a medical emergency, call your local emergency number right away.
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