Abstract: Purpose: Two to three weeks after birth is the best time to perform ArterySwitchOperation (ASO) in children with transposition of the great arteries with intact ventricular septum (TGA-IVS); beyond this age children with degenerated left ventricular myocardium may have difficulty with body circulation pressure after direct action artery switch operation. This article summarizes the choice of surgical approach and the early and mid-term outcomes of treatment in 36 such children. METHODS: Between March 2000 and June 2007, 36 children aged more than 3 weeks with TGA-IVS were admitted to our hospital, accounting for 23.9% of children with ASO for TGA during the same period. There were 26 males and 10 females; ages ranged from 22 to 2190 (189.5±358.3) days, including 20 cases younger than 3 months and 3 cases older than 1 year; weights ranged from 3.5 to 19.0 (5.4±2.9) kg. 21 cases were divided into 2 groups according to the surgical method: the first stage surgery group (group A) and 15 cases in the staged surgery group (group B.) In group B, left ventricular function exercise was performed first and then ASO was performed in the second stage. In group B, functional left ventricular exercise was performed first, and then ASO was performed in the second stage, including 14 cases of rapid second-stage surgery and 1 case of long-term second-stage surgery. The mean age and preoperative left and right ventricular pressure ratio (LVP/RVP) were statistically significantly different between the two groups. Thirty-two/34 cases were followed up for 2 to 74 (20.3±19.1) months. RESULTS: There were 2 perioperative deaths due to pulmonary infection and renal failure, respectively, and hepatic and renal failure due to cytomegalovirus infection, and there was no death due to left heart failure in this group. There were 3 cases of distant death, with the time of death ranging from 3 to 6 months after surgery, and the 3-year survival rate was 88.8%. The surviving children had good quality of life and growth and development, and normal left ventricular systolic function. CONCLUSION: Children with TGA-IVS who missed the best time for surgery were treated satisfactorily with reasonable selection of stage I and stage I ASO with reference to preoperative ultrasound and intraoperative manometry, and with enhanced postoperative management.