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We analyzed ventricular function after BDCPC according to ventricular morphology and correlated this evolution to long-term prognosis. A review from Mayo Clinic databases was performed. Visually estimated ejection fraction (EF) was reported from pre-BDCPC to pre-Fontan procedure. The last cardiovascular update was collected to assess long-term prognosis. A freedom from major cardiac event survival curve and a risk factor analysis were performed. 92 patients were included; 52 had left ventricle (LV) morphology and 40 had right ventricle (RV) morphology (28\/40 had hypoplastic left heart syndrome (HLHS)). There were no significant differences in groups regarding BDCPC procedure or immediate post-operative outcome. EF showed a significant and relevant decrease from baseline to discharge in the HLHS group: 59\u2009\u00b1\u20094% to 49\u2009\u00b1\u20097% or \u2212 9% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) vs. 58\u2009\u00b1\u20093% to 54\u2009\u00b1\u20096% or \u2212 4% in the non-HLHS RV group (<jats:italic>p<\/jats:italic>\u2009=\u20090.04) and 61\u2009\u00b1\u20094% to 60\u2009\u00b1\u20094% or \u2212 1% in the LV group (<jats:italic>p<\/jats:italic>\u2009=\u20090.14). Long-term recovery was the least in the HLHS group: EF prior to Fontan 54\u2009\u00b1\u20092% vs. 56\u2009\u00b1\u20096% and 60\u2009\u00b1\u20094%, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). With a median follow-up of 8\u00a0years post-BDCPC, six patients had Fontan circulation failure, four died, and three had heart transplantation. EF less than 50% at hospital discharge after BDCPC was strongly correlated to these major cardiac events (HR 3.89; 95% Cl 1.04\u201314.52). Patients with HLHS are at great risk of ventricular dysfunction after BDCPC. This is not a transient phenomenon and contributes to worse prognosis.<\/jats:p>","DOI":"10.1007\/s00246-020-02433-9","type":"journal-article","created":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T14:07:32Z","timestamp":1597154852000},"page":"1714-1724","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8201-5024","authenticated-orcid":false,"given":"Marie","family":"Vincenti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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