The third stage for palliative surgical reconstruction for children with functional single-ventricle (SV) physiology is the completion of the total cavopulmonary connection (TCPC), where the superior vena cava (SVC) and inferior vena cava (IVC) are routed directly into the pulmonary arteries. Approximately 5000 newborns in the US each year join to the existing SV (or Fontan) patient population, along with increasing numbers of adult Fontan patients surviving longer due to the advances in surgical techniques and post-op management. Although most post-operative Fontan patients experience an acceptable quality of life, their lifespan is shorter than normal with a significant number of these patients developing late hemodynamic complications (failing Fontan) and requiring heart transplantation. Donor shortage and the high-risk nature of transplantation for these complex and often very ill patients demand alternative therapeutic options [1].

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