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J Am Coll Cardiol. 2017 Jan 3;69(1):43-51. doi: 10.1016/j.jacc.2016.10.051.

Transposition of the Great Arteries in the Developing World: Surgery and Outcomes.

Author information

Children's National Heart Institute, Children's National Medical Center, George Washington University, Washington, DC. Electronic address:
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto, Brazil.
Children's Hospital 1, Ho Chi Minh City, Vietnam.
Care Hospital, Hyderabad, India.
Department of Surgery, University of Tennessee Health Science Center and William Novick Global Cardiac Alliance, Memphis, Tennessee.
Fundación Cardioinfantil IC, Bogotá, Colombia.
UNICAR and the Fundación Aldo Castañeda, Guatemala City, Guatemala.



Little has been published regarding surgery for transposition of the great arteries (TGA) in the developing world.


This study sought to identify patient characteristics, surgical interventions, institutional characteristics, risk factors for mortality, and outcomes among patients undergoing surgery for TGA in this setting.


Developing world congenital heart surgical programs submitted de-identified data to a novel international collaborative database as part of a quality improvement project. We conducted a retrospective cohort study that included all cases of TGA with intact ventricular septum and TGA with ventricular septal defect performed from 2010 to 2013. Demographic, surgical, and institutional characteristics and their associations with in-hospital mortality were identified.


There were 778 TGA operations performed at 26 centers, 480 (62%) for TGA with intact ventricular septum and 298 (38%) for TGA with ventricular septal defect. Most (80%) were single-stage arterial switch operations, but 20% were atrial baffling procedures (atrial switch operation) or 2-stage repairs (pulmonary artery band followed by arterial switch operation). Age at operation was >30 days in one-half of the cases and did not vary significantly with operation type. Survival was 85% and did not significantly vary with age at operation or operation type. Preceding septostomy was infrequently reported (16%) and was not associated with surgical mortality. Mortality was associated with lower World Health Organization weight/body mass index-for-age percentile and lower institutional volume of TGA repair.


Surgical repair of TGA performed in the developing world is associated with an early survival of 85%. Type of surgical repair and age at operation varied considerably, but no associations with mortality were identified. In contrast, poor nutrition and small surgical volume were most strongly associated with mortality. Multicenter collaborative quality improvement efforts may benefit patients with TGA in the developing world.


arterial switch operation; congenital heart surgery; international; mortality; resource limited

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