In the past two decades the arterial switch operation (ASO)has become the preferred surgical procedure for transposition of the great arteries (TGA). After the first successful ASO in 1975 by Jatene a considerable number of series have been reported. In contrast to the atrial switch procedures (Mustard or Senning), ASO has the advantages of maintenance of sinus node function, preservation of the left ventricle as the systemic ventricle, and the mitral valve as the systemic atrioventricular valve. According to our study the ASO remains the procedure of choice for the treatment of various forms of the TGA with acceptable early and later outcome in terms of overall survival and free reoperation. The reconstruction of the pulmonary root employing a single “pantaloon patch” seems to offer less residual pulmonary artery stenosis. Patients with a ventricular septal defect and a significant mismatch between the neo-aortic root and distal aorta are at a higher risk for developing postoperative neo- aortic valve regurgitation.The post ASO coronary obstruction can be treated with excellent results employing internal mammary artery grafting and surgical coronary ostial plasty.