A Comparison of the Burden of Postoperative Recovery Between Complex Biventricular Repair and Fontan Operations

Complex biventricular repair (BVR) may have long-term benefits compared with single-ventricle palliation. However, in some patients BVR may be deferred out of concerns regarding poor short-term outcomes, reinterventions, and difficult recovery. This study 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 patients in the BVR cohort underwent staged repair, 4 of whom are awaiting second-stage completion. BVR operations were compared with 155 contemporary Fontan operations (median age, 4.2 years) performed between 2018 and 2025. Perioperative and 1-year outcomes were reported from each group.

In the perioperative period, mortality (0 [0%] vs 8 [5.2%]), length of stay (median, 11.0 days vs 11.5 days), extracorporeal membrane oxygenation (2 [5%] vs 9 [5.8%]), pacemaker implantation (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 days vs 0 days). At 1 year postoperatively, all-cause mortality was 0 (0%) for BVR operations and 9 (5.8%) for Fontan operations. Freedom from a composite end-point of mortality, extracorporeal membrane oxygenation, heart transplantation, pacemaker implantation, and unplanned reintervention was similar between the BVR and Fontan cohorts at a mean follow-up period of 1.4 years for the BVR cohort.

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