Surgical Outcomes of Arterial Switch Operations in Southern Thailand: A 15-Year Experience from a University Hospital
Supphamongkhon Khunakanan, MD¹, Pongsanae Duangpakdee, MD¹, Surasak Sangkhathat, MD, PhD¹,², Phuripong Rodneam, MD¹, Parin Boonthum, MD¹, Voravit Chittithavorn, MD¹
Affiliation : ¹ Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; ² Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Background: Transposition of the great vessels (TGA) is the second most common congenital cyanotic cardiac defect in infants. Fortunately, correction via arterial switch operations (ASO) is possible.
Objective: To review the early experiences of a university hospital in Southern Thailand performing ASO. Factors associated with 90-day survival were analyzed and compared with three anatomical subtypes of dextro-transposition for TGA, TGA with intact ventricular septum (TGA/IVS), ventricular septal defects (TGA/VSD), and Taussig-Bing anomaly (DORV/TGA).
Materials and Methods: Patient electronic medical records with TGA having undergone ASO at Songklanagarind Hospital, Thailand, between 2010 and 2024 were retrospectively reviewed. The primary outcome measurement was 90-day survival. Survival outcomes, re-operation, and complications were also analyzed. Data were compared between those with good and poor outcomes, and among types of TGA.
Results: Over the 15-year period, 78 consecutive cases were identified: TGA/IVS 48 (61.5%), TGA/VSD 20 (25.6%), and DORV/TGA 10 (12.8%). Median age at operation was 15 days (interquartile range 9.25 to 26.25), with the DORV/TGA group being the highest (45 days). Overall, the 90-day survival rate was 65.4%: trending towards improved survival over time. Surgical complications, especially valvular complications and pulmonary hypertension, were significantly associated with the 90-day mortality odds ratio. Pre-ASO balloon atrial septostomy was performed in 42.3% of cases, with the TGA/IVS group having a significantly higher frequency. The Kaplan-Meier survival curves indicated poorer survival in the DORV/TGA group, although the difference in survival probability among the three groups was not statistically significant. Patients receiving pre-ASO interventions had significantly higher survival rates.
Conclusion: Patient survival for TGA having undergone ASO improved with the learning curve. Perioperative care, especially pre-ASO intervention and early operation, may be the key to improving outcomes.
Received 10 October 2025 | Revised 29 January 2026 | Accepted 18 February 2026
DOI: 10.35755/jmedassocthai.2026.4.03395
Keywords : Arterial switch operation; Congenital heart disease; Transposition of the great vessels
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