A Comparison of the Burden of Post-Operative Recovery Between Complex Biventricular Repair and Fontan Operations

Complex biventricular repair (BVR) may have long-term benefits compared to single ventricle palliation. However, in some patients BVR may be deferred due to concerns regarding poor short-term outcomes, re-interventions, and difficult recovery. We aimed to describe procedural and 1-year outcomes in patients undergoing BVR or Fontan operations.

Between 2023 and 2025, 40 patients previously considered for single ventricle palliation underwent 51 BVR operations, at a median age of 1.1 years. Sixteen BVR patients underwent staged repair, of which 4 are awaiting second stage completion. BVR operations were compared to 155 contemporary Fontan operations (median age 4.2 years) performed between 2018 and 2025. Peri-operative and 1-year outcomes were reported from each group.

In the peri-operative period, mortality (0 [0%] vs 8 [5.2%]), length of stay (median 11.0 vs 11.5 days), extracorporeal membrane oxygenation (ECMO) (2 [5%] vs 9 [5.8%]), pacemaker (4 [10%] vs 6 [3.9%]), and reoperation (1 [2.5%] vs 11 [7.1%]) were similar between BVR and Fontan operations. BVR operations were associated with increased ventilator days (median 2.0 vs 0). At 1-year after surgery, all-cause mortality was 0 (0%) for BVR operations and 9 (5.8%) for Fontan operations. Freedom from a composite end-point of mortality, ECMO, heart transplant, pacemaker, and unplanned re-intervention was similar between BVR and Fontan patients at a mean follow-up of 1.4 years for BVR patients.

Despite historical concerns about high procedural morbidity with BVR operations, contemporary short-term outcomes are comparable to Fontan operations in well-selected patients.