Comparative Outcomes of Single-Stage Fontan Procedure Versus Staged Fontan Following Glenn Procedure in Single-Ventricle Patients

Objectives The role of single-stage Fontan completion, performed without a preceding bidirectional Glenn, remains controversial in late-presenting patients and resource-limited settings. We compared early and midterm outcomes of single-stage and staged Fontan. Methods This was a retrospective review of consecutive patients undergoing Fontan completion at a tertiary congenital cardiac center between January 2003 and December 2025. Cohorts were grouped by whether Fontan was direct (single-stage) or after prior bidirectional Glenn (staged). Primary endpoints were in-hospital mortality and 1-year survival; secondary endpoints included complications, intensive care unit (ICU) and hospital stay, and midterm survival. Results Of the 118 patients (single-stage n = 66; staged n = 52), single-stage patients were older (median age 11 vs 8 years; P = .002), with higher mean pulmonary artery pressure (14.9 ± 3.4 vs 12.1 ± 3.3 mm Hg; P < .001) and lower ventricular ejection fraction (60% vs 67.5%; P = .01). Despite this, in-hospital mortality (9.1% vs 5.8%; P = .729), Kaplan-Meier 1-year survival (87.6% vs 94.2%; P = .59) and 5-year survival (87.6% vs 92.0%) did not differ. ICU stay (median 4 days), hospital stay (14 vs 15 days), and complications were comparable. Fontan-associated liver disease occurred in 17 of 109 patients (15.6%; 20.3% vs 10.0%; P = .138). Conclusion Despite less favorable baseline hemodynamics, early and midterm outcomes after single-stage Fontan were comparable to staged Fontan. Single-stage Fontan is a reasonable option for appropriately evaluated late-presenting patients in resource-constrained settings; multicenter studies are required to refine selection criteria.