The role of aortic translocation in the management of complex transposition of the great arteries.

The surgical management of transposition of the great arteries with a ventricular septal defect and left ventricular outflow tract obstruction still remains a significant challenge despite major advances in pediatric cardiovascular surgery. Almost four decades after its inception, the Rastelli procedure continues to be the standard surgical technique used in the management of these patients, despite less than optimal long-term results. Aortic translocation with biventricular outflow tract reconstruction is an alternative surgical technique that creates anatomically sound connections between the ventricles and their respective great arteries, which could result in better long-term outcomes. This technique is especially useful in patients with transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction who have an inlet or restrictive ventricular septal defect, a small right ventricle, a straddling atrioventricular valve, or an aberrant coronary artery crossing the right ventricular outflow tract.