Background-
Systemic ventricular failure is a well documented long term consequence of atrial switch procedures (ASP). Heart transplantation remains the only available treatment.

Objective-
To evaluate outcome of heart transplantation for systemic ventricular failure late after atrial switch procedure.

Materials,Methods-
Retrospective analysis of patients undergoing orthotopic heart transplantation following previous atrial switch procedure. During the period 1985-2008 we performed orthotopic heart transplants in 824 patients. 13 patients had a primary diagnosis of Transposition of the Great Arteries (TGA) of whom 8 had prior Mustard and 5 had prior Senning procedures.

Results-
In these 13 patients there were 3 deaths within the first 30 days after transplant (donor organ failure, stroke, and acute rejection), 2 deaths later in the first year (acute rejection, lymphoma) and one further death at nearly seven years post-transplant (graft coronary artery disease). Actuarial survival (compared with other adult recipients) was 76.0% (86.8%) at 30 days, 56.5% (80.7%) at one year and 56.5% (71.8%) at 5 years.

Conclusion-
While heart transplantation for failed atrial switch carries a relatively high early post-operative mortality, mid to long term results are good.However, technical challenges remain and there is still room for improvement.