Background: Indications and outcomes of the arterial switch operation in children who are older than 1 month of age and have transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly were studied. Methods: Arterial switch operation was performed in 68 children between January 2000 and December 2008. Thirty infants (1 to 6 months old) had transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly (group A), and 38 children older than 6 months of age had transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly (group B). The preoperative pulmonary artery pressure in group B was significantly higher than that in group A (46.5 ± 16.3 mm Hg and 31.3 ± 8.6 mm Hg, respectively; p < 0.05). Arterial switch operation was performed under general anesthesia, hypothermia (18° to 22°C), and low-flow (50 mL · kg-1 · min-1) extracorporeal bypass circulation. Concomitant cardiac anomalies were treated during the same surgical session. Results: Average extracorporeal circulation time, aortic clamping time, postoperative overall hospitalization, and intensive care unit duration were not significantly different between the two groups (p > 0.05). The operative mortality rate in group A was 10.0% (3 of 30 patients) and in group B, 7.9% (3 of 38 patients; p > 0.05). Follow-up examinations in the surviving 62 patients after a mean of 13.5 ± 7.9 months (range, 0.5 to 56 months) showed significantly improved cardiac function without any long-term complications, and no cases of death occurred during this period. Conclusions: Arterial switch operation shows satisfactory operative outcome of transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly in children older than the age of 6 months with moderate-to-severe pulmonary hypertension. © 2009 The Society of Thoracic Surgeons.