The arterial switch operation for transposition of the great vessels is best performed:
A. Within 2 weeks of birthThe most important consideration is the timing of surgical repair, because arterial switch should be performed within 2 weeks after birth, before the LV loses its ability to pump against systemic afterload. In patients presenting later than 2 weeks, the LV can be retrained with preliminary pulmonary artery banding and aortopulmonary shunt followed by definitive repair. Alternatively, the unprepared LV can be supported following arterial switch with a mechanical assist device for a few days while it recovers ability to manage systemic pressures. Echocardiography can be used to assess left ventricular performance and guide operative planning in these circumstances.