Medical Practice Technical Challenges


Arterial Switch Operation for Transposition of the Great Arteries - Hands-On

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April 1st 2022
George Sarris (MD, PhD)
Transposition of the Great Arteries (TGA) is a complex congenital heart defect (CHD), however, with proper diagnosis, management and surgical treatment its prognosis is excellent.

The surgical procedure indicated to anatomically repair this defect has been established as the Arterial Switch Operation. This technically demanding procedure is not only necessary for the treatment of TGA, but also it encompasses surgical skills necessary for corrective procedures for many other congenital cardiac lesions, therefore it is considered one of the most important procedures which a congenital heart surgeon must master.

There are many serious obstacles for a developing congenital surgeon to learn how to perform this procedure, and, correspondingly, for an experienced surgeon to teach it to a trainee:

The condition is relatively rare, therefore, even in large congenital heart surgery units, only a small number of such operations are performed every year. Since the operation is complex and must be performed in frail neonates, the risk to the patient of entrusting the procedure to a trainee or to a less experienced surgeon is considered to be considerable. Therefore, the master surgeon may be reluctant, and rightly so, to use such cases as teaching cases.

On the other hand, there are no animal models of TGA which might provide the substrate for surgical training without using the patient as a teaching substrate.

Fortunately, 3D printing technology allows the creation of highly accurate, life-size physical model-replicas of the hearts of real neonates with TGA, and they can be used as teaching substrates in surgical simulation.
Post–graduate trainees in paediatric and congenital heart surgery
Early career paediatric and congenital heart surgeons
  1. Understand the basic TGA theoretical background information
  2. Perform the essential components of the arterial switch operation in a 3D-printed surgical simulation model under expert guidance.
  3. Have the opportunity to ask experts in the ASO questions which are informed on the theoretical presentations and, most importantly, on the hand-on surgical simulation experience with the arterial switch operation.
Prior clinical experience (at any level as trainee or early career congenital surgeon) with transposition of the great arteries and the arterial switch operation