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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Pediatric Cardiology · Dextro-transposition of the great arteries

Will My Baby Have a Mustard or Senning Procedure?

At a Glance

Babies born today with typical d-TGA almost certainly receive the Arterial Switch Operation (ASO), not the older Mustard or Senning procedures. The ASO restores the heart's normal anatomy, allowing the strong left ventricle to pump blood to the body, leading to much better long-term health.

In this answer

4 sections

01

The Historical Approach: Mustard and Senning Procedures

02

The Modern Standard: Arterial Switch Operation (ASO)

03

Why This Matters for Your Baby’s Future

04

Ongoing Care

Your baby will almost certainly have the Arterial Switch Operation (ASO), not a Mustard or Senning procedure, provided they have typical (simple) dextro-transposition of the great arteries (d-TGA). (Babies with complex d-TGA, which includes additional structural defects, might require different specialized surgeries.)

If you have been searching online and reading about adult survivors with d-TGA, it is easy to become confused and alarmed. Many adults living with d-TGA today were born before the 1980s and underwent the Mustard or Senning surgeries [1][2]. The ASO has since replaced those older surgeries as the modern standard of care [3][1]. Understanding how these surgeries differ is key to understanding why your baby’s long-term outlook is much brighter.

The Historical Approach: Mustard and Senning Procedures

The Mustard and Senning procedures are known as atrial switch or physiological repairs. Before surgical techniques advanced enough to safely move tiny blood vessels in newborns, surgeons found a workaround to help babies survive.

Instead of moving the major arteries to their correct positions, surgeons worked inside the upper chambers of the heart (the atria). They built a tunnel or “baffle” that redirected oxygen-poor blood to the lungs and oxygen-rich blood to the body [1].

While this saved many lives, it created a long-term problem: it left the right ventricle (one of the lower pumping chambers) to pump blood to the entire body [4]. The right ventricle is naturally designed to pump blood only a short distance to the lungs at a low pressure. Forcing it to do the heavy, high-pressure lifting for the whole body for decades takes a toll. This is why adults who had these older procedures are at a high risk for late complications, including systemic right ventricular dysfunction (heart failure), serious heart rhythm issues (arrhythmias), and a higher risk of premature death [5][6][7].

The Modern Standard: Arterial Switch Operation (ASO)

The Arterial Switch Operation is an anatomical repair typically performed in the first few days or weeks of life. It was made possible by advances in neonatal surgery, anesthesia, and intensive care [8][9]. Rather than creating a workaround, the surgeon actually restores the heart’s normal anatomy.

During an ASO, the surgeon cuts the aorta and the pulmonary artery and swaps them to their correct positions [2][1]. Crucially, the surgeon also carefully detaches the tiny coronary arteries (which supply blood to the heart muscle itself) and moves them to the new aorta.

Because the anatomy is restored to normal, the strong, muscular left ventricle takes over the job of pumping blood to the rest of the body—exactly as nature intended [4].

Why This Matters for Your Baby’s Future

The shift from atrial switches to the Arterial Switch Operation has completely transformed what it means to live with d-TGA. Because the left ventricle is doing the work, children who have an ASO today experience vastly superior long-term, transplant-free survival compared to those who had the older surgeries [10][11][7].

They generally have better exercise capacity, fewer heart rhythm problems, and even better outcomes if they decide to carry a pregnancy later in life [12][13][4].

Ongoing Care

While the ASO is a highly successful surgery that allows most children to live normal, active lives, it is not a “cure” that allows you to stop seeing a cardiologist. Your child will still need lifelong monitoring, typically with regular echocardiograms (ultrasounds of the heart). Doctors will watch for specific issues unique to the ASO, such as:

  • Neo-aortic root dilatation: Stretching of the new aortic valve, which can sometimes cause it to leak over time [14][15].
  • Pulmonary stenosis: Narrowing of the pulmonary artery where it was reattached [14][16].
  • Coronary artery issues: Ensuring the relocated coronary arteries continue to provide good blood flow to the heart muscle [17][18].

If these complications do occur, they can often be treated with a minimally invasive catheter procedure, though some cases may require additional surgery. When you read stories from adult survivors online, remember that the surgical landscape has changed dramatically. The modern ASO gives your baby a strong foundation for a healthy life.

Common questions in this guide

Will my baby need a Mustard or Senning procedure for d-TGA?
No, if your baby has typical d-TGA, they will almost certainly have an Arterial Switch Operation (ASO). The Mustard and Senning procedures are older surgeries that have been replaced by the ASO as the modern standard of care.
What is the difference between an atrial switch and an arterial switch?
An atrial switch (like the Mustard or Senning) redirects blood flow inside the upper heart chambers, leaving the weaker right ventricle to pump blood to the body. The arterial switch (ASO) actually swaps the major arteries to their correct positions, allowing the stronger left ventricle to pump.
Why do older adults with d-TGA have so many heart complications?
Many adults born before the 1980s had a Mustard or Senning procedure. These surgeries forced the right ventricle to pump high-pressure blood to the entire body for decades, which often leads to heart failure and arrhythmias over time. Babies having the ASO today have a much brighter outlook.
Will my child be fully cured after the Arterial Switch Operation?
While the ASO is highly successful and allows most children to live active lives, it is not a complete cure. Your child will still need lifelong monitoring with a cardiologist to watch for issues like narrowing pulmonary arteries or aortic valve stretching.
How does complex d-TGA change the surgical plan?
Complex d-TGA involves additional structural heart defects beyond the reversed arteries. These extra defects might require a different specialized surgical plan than the standard Arterial Switch Operation used for simple d-TGA.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does my baby have simple d-TGA, or are there additional complex structural defects that might change the surgical plan?
  2. 2.How many neonatal Arterial Switch Operations does your surgical team perform each year?
  3. 3.What does the typical timeline look like for my baby's surgery and recovery in the hospital?
  4. 4.What will our follow-up schedule and cardiac testing (like echocardiograms) look like in the first year after the ASO?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Can Children with Repaired D-TGA Play Competitive Sports?Can You Breastfeed After an Arterial Switch Operation?Can I Have a Vaginal Delivery With Fetal D-TGA?How Coronary Variations Affect Arterial Switch SurgeryHow Does a VSD Affect the Arterial Switch Operation?Is D-TGA Genetic? Recurrence Risk for Future PregnanciesHow Does ASO Surgery Affect Brain Development?What Are the Symptoms of D-TGA in Newborns?What is a Balloon Atrial Septostomy (Rashkind Procedure)?What is the Difference Between D-TGA and L-TGA?What Is the I-Sign on a Fetal Ultrasound for D-TGA?What is the Risk of Surgery After an Arterial Switch?Why Do Babies on Prostaglandin E1 Need Intubation?Why is Early Arterial Switch Surgery Critical for D-TGA?

References

References (18)
  1. 1

    Management of the Adult with Arterial Switch.

    Breinholt JP, John S

    Methodist DeBakey cardiovascular journal 2019; (15(2)):133-137 doi:10.14797/mdcj-15-2-133.

    PMID: 31384376
  2. 2

    Dextro-Transposition of the Great Arteries: Long-term Sequelae of Atrial and Arterial Switch.

    Haeffele C, Lui GK

    Cardiology clinics 2015; (33(4)):543-58, viii.

    PMID: 26471819
  3. 3

    Arrhythmias Following the Mustard and Senning Operations for Dextro-Transposition of the Great Arteries: Clinical Aspects and Catheter Ablation.

    Baysa SJ, Olen M, Kanter RJ

    Cardiac electrophysiology clinics 2017; (9(2)):255-271 doi:10.1016/j.ccep.2017.02.008.

    PMID: 28457240
  4. 4

    Pregnancy outcomes and mid-term prognosis in women after arterial switch operation for dextro-transposition of the great arteries - Tertiary hospital experiences and review of literature.

    Horiuchi C, Kamiya CA, Ohuchi H, et al.

    Journal of cardiology 2019; (73(3)):247-254 doi:10.1016/j.jjcc.2018.11.007.

    PMID: 30579805
  5. 5

    Mechanisms for heart failure in systemic right ventricle.

    Andrade L, Carazo M, Wu F, et al.

    Heart failure reviews 2020; (25(4)):599-607 doi:10.1007/s10741-019-09902-1.

    PMID: 31853794
  6. 6

    Atrial arrhythmia predicts late events and mortality in patients with D-transposition of the great arteries and atrial switch repair.

    Chiriac A, Giardi D, Cheema KP, et al.

    International journal of cardiology. Congenital heart disease 2024; (15()):100491 doi:10.1016/j.ijcchd.2023.100491.

    PMID: 39713489
  7. 7

    Late Survival and Patient-Perceived Health Status of the Congenital Heart Surgeons' Society dextro-Transposition of the Great Arteries Cohort.

    Devlin PJ, Jegatheeswaran A, Williams WG, et al.

    The Annals of thoracic surgery 2019; (108(5)):1447-1455 doi:10.1016/j.athoracsur.2019.05.081.

    PMID: 31348901
  8. 8

    Transposition of the Great Arteries and Common Variants.

    Wernovsky G

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2016; (17(8 Suppl 1)):S337-43 doi:10.1097/PCC.0000000000000819.

    PMID: 27490620
  9. 9

    Outcomes after the Mustard, Senning and arterial switch operation for treatment of transposition of the great arteries in Finland: a nationwide 4-decade perspective.

    Raissadati A, Nieminen H, Sairanen H, Jokinen E

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2017; (52(3)):573-580 doi:10.1093/ejcts/ezx107.

    PMID: 28444256
  10. 10

    Long-Term Survival After Arterial Versus Atrial Switch in d-Transposition of the Great Arteries.

    Kiener A, Kelleman M, McCracken C, et al.

    The Annals of thoracic surgery 2018; (106(6)):1827-1833 doi:10.1016/j.athoracsur.2018.06.084.

    PMID: 30172857
  11. 11

    Incidence and long-term outcomes of dextro-transposition of the great arteries (d-TGA) in the Kingdom of Bahrain.

    AlAraibi AJ, Shakeeb FN, Shakeeb ZN, et al.

    Frontiers in cardiovascular medicine 2025; (12()):1691860 doi:10.3389/fcvm.2025.1691860.

    PMID: 41333748
  12. 12

    Outcome of Pregnancy in Women With D-Transposition of the Great Arteries: A Systematic Review.

    Pizula J, Devera J, Ng TMH, et al.

    Journal of the American Heart Association 2022; (11(23)):e026862 doi:10.1161/JAHA.122.026862.

    PMID: 36444833
  13. 13

    Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme.

    Tutarel O, Ramlakhan KP, Baris L, et al.

    Journal of the American Heart Association 2021; (10(1)):e018176 doi:10.1161/JAHA.120.018176.

    PMID: 33350866
  14. 14

    Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries.

    van der Palen RLF, Deurvorst QS, Kroft LJM, et al.

    Journal of magnetic resonance imaging : JMRI 2020; (51(4)):1105-1116 doi:10.1002/jmri.26934.

    PMID: 31591799
  15. 15

    Evolving concern: Late outcomes after repair of transposition of the great arteries.

    Rocha RV, Barron DJ, Mazine A, et al.

    The Journal of thoracic and cardiovascular surgery 2025; (169(5)):1296-1303.e2 doi:10.1016/j.jtcvs.2024.11.032.

    PMID: 39617321
  16. 16

    30 years' experience with the arterial switch operation: risk of pulmonary stenosis and its impact on post-operative prognosis.

    Sobczak-Budlewska K, Łubisz M, Moll M, et al.

    Cardiology in the young 2023; (33(9)):1550-1555 doi:10.1017/S1047951122002670.

    PMID: 36040409
  17. 17

    Cardiac Magnetic Resonance Myocardial Perfusion After Arterial Switch for Transposition of Great Arteries.

    Raimondi F, Aquaro GD, De Marchi D, et al.

    JACC. Cardiovascular imaging 2018; (11(5)):778-779 doi:10.1016/j.jcmg.2017.07.015.

    PMID: 29055630
  18. 18

    Neoaortic outcomes after the arterial switch operation: A systematic review and meta-analysis.

    Negm S, Mahmoud AB, Desnous B, et al.

    Archives of cardiovascular diseases 2026; (119(3)):233-243 doi:10.1016/j.acvd.2025.08.013.

    PMID: 41193284

This page explains surgical procedures for d-TGA for educational purposes. Always consult your pediatric cardiologist and surgical team for your baby's specific treatment plan and outlook.

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