This week we review a fascinating very long-term surgical follow-up study from the team at Royal Children's Hospital in Melbourne reviewing over 30 year follow-up following the arterial switch operation for the treatment of transposition of the great vessels. What percentage of patients need reintervention by 30 years post neonatal repair? What anatomical sub-types are more likely to be associated with a need for reintervention and why? When intervention is required for neo-aortic or aortic root problems, can these usually be repaired or do they require replacement? Professor Igor Konstantinov from Melbourne shares his deep insights into this complex patient group.