Life-saving heart surgery is always required. It is ideally performed on an infant between 8–14 days old. The heart and vessels are accessed via median sternotomy, and a
cardiopulmonary bypass machine is used; as this machine needs its "circulation" to be filled with blood, a child will require a
blood transfusion for this surgery. The procedure involves
transecting both the aorta and pulmonary artery; the coronary arteries are then detached from the aorta and reattached to the
neo-aorta, before "swapping" the upper portion of the aorta and pulmonary artery to the opposite arterial
root. Including the
anaesthesia and immediate
post operative recovery, this surgery takes an average of approximately six to eight hours to complete. Some arterial switch recipients may present with post-operative pulmonary stenosis, which would then be repaired with angioplasty, pulmonary
stenting via heart cath or median sternotomy, and/or
xenograft.
Atrial switch In some cases, it is not possible to perform an arterial switch, either because of late diagnosis,
sepsis, or a
contraindicative coronary artery pattern. In the case of sepsis or late diagnosis, a delayed Arterial Switch can sometimes be made possible by PAB, which may also require a concomitant construction of an aortic-to-pulmonary artery shunt. Both methods involve creating a
baffle to redirect red and blue blood flow to the appropriate artery. Since the late 1970s the Mustard procedure has been preferred.
Post-operative Following corrective surgery, but prior to cessation of anaesthesia, two small incisions are made immediately below the sternotomy incision which provide exit points for
chest tubes used to drain fluid from the thoracic cavity, with one tube placed at the front and another at the rear of the heart. The patient returns to the ICU post-operatively for recovery, maintenance, and close observation; recovery time may vary, but tends to average approximately two weeks, after which the patient may be transferred to a
Transitional Care Unit (
TCU), and eventually to a
cardiac ward. Post-operative care is very similar to the palliative care received, with the exception that the patient no longer requires PGE or the surgical palliation procedures. Additionally, the patient is kept on a cooling blanket for a period of time to prevent
fever, which could cause
brain damage. The sternum is not closed immediately which allows extra space in the
thoracic cavity, preventing excess pressure on the heart, which
swells considerably following the surgery; the sternum and incision are closed after a few days, when swelling is sufficiently reduced.
Follow-up The infant will continue to see a
cardiologist on a regular basis. Although these appointments are required less frequently as time goes on, they will continue throughout the lifetime of the individual, and may increase in the event of complications or as the individual approaches
middle age. The cardiology exam may include an echocardiogram, EKG, and/or
cardiac stress test in addition to consultation. Additionally, some individuals may require ongoing medication therapy at home, which may include diuretics (such as
furosemide or
spironolactone), analgesics (such as
paracetamol), cardiac glycosides (such as
digoxin),
anticoagulants (such as
heparin or
aspirin), or other medications. If the individual has undergone stenting, an anticoagulant will be a necessity to prevent build-up around the stent(s), as the body will perceive the foreign body as a wound and attempt to heal it. Some patients who had alternate corrective surgery, such as the Mustard or Senning procedure, may have issues with SA and VA nodal transmissions in later life. Typical symptoms include palpitations and problems with low heart rates. This is commonly solved with a Pacemaker unit, providing scar tissue from the original operation does not block its functionality. More recently, ACE inhibitors have been prescribed to patients in the hope of relieving stress on the heart. ==Prognosis==