The records of all children with simple (n = 73) and complex (n = 35) transposition of the great arteries who were born in western Sweden during 1964-83 were studied. The incidence was 0.24/1000 births. The preoperative mortality decreased from 100%, in 1964, before palliation was introduced, to 16% at the end of the study period. Sixty-six underwent corrective procedures: 37 Mustard, 21 Senning, 3 arterial switch and 5 Rastelli operations. The perioperative mortality, which was 26% in simple transposition and 75% in complex, did not decrease significantly during the study period. Of 39 hospital survivors, eight Mustard and two Senning patients died late of baffle complications (n = 2), sudden death (n = 6), pulmonary vascular disease (n = 1) and systemic ventricle dysfunction (n = 1). The cumulative 20-year survival was 32% in simple transposition and 17% in complex. In a pioneer population with transposition, long-term survival was unsatisfactory. This was caused by continuing high perioperative mortality and late deaths.