The end result is that the aorta is repositioned behind the pulmonary arteries, functionally lengthening it and causing less angulation at the coronary origins.

[4] The Jatene procedure is ideally performed during the second week of life, before the left ventricle adjusts to the lower pulmonary pressure and is therefore unable to support the systemic circulation.

[6] The success of ASO procedure is largely dependent on the facilities available, the skill and experience of the surgeon, and the general health of the patient.

[7] Approximately 10% of arterial switch recipients develop residual pulmonary stenosis post-operatively, which can lead to right heart failure if left untreated;[8] treatment usually involves endovascular stenting and/or xenograft patching.

The coronary arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta.

[citation needed] As the patient is anesthetized, they may receive the following drugs, which continue as necessary throughout the procedure: The heart is accessed via median sternotomy and its pericardium is removed so the coronary and great arteries can be seen.

The ductus arteriosus and main right pulmonary artery, up to and including the first branches in the hilum of the right lung, are separated from the surrounding supportive tissue to allow mobility of the vessels.

Cardiopulmonary bypass is then initiated and the body is cooled to prevent the brain damage otherwise associated with low blood flow during the surgery.

The bypass machine is then turned off, an incision is made in the right atrium, through which the congenital or palliative atrial septal defect is repaired.

The patient will continue to fast for up to a few days, and breastmilk or infant formula can then be gradually introduced via nasogastric tube (NG tube); the primary goal after a successful arterial switch, and before hospital discharge, is for the infant to gain back the weight they have lost and continue to gain weight at a normal or near-normal rate.

[10] In 1950, American surgeons Alfred Blalock and C. Rollins Hanlon introduced the Blalock-Hanlon atrial septectomy, which was then routinely used to palliate patients.

[17] Egyptian cardiac surgeon Magdi Yacoub was subsequently successful in treating TGA with AN intact interventricular septum when preceded by pulmonary artery banding and systemic-to-pulmonary shunt palliation.

Older age at time of ASO, presence of ventricular septal defect, and previous PA banding have been found to be risk factors for AR.