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This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort\u2019s mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M\/F 512\/384, median age: 4.5\u00a0years (IQR 3.3\u20136.4), median weight 16\u00a0kg (IQR 14\u201322). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4\u00a0years was associated with an early need for transcatheter reintervention (adj\n                    <jats:italic>p<\/jats:italic>\n                    value\u2009=\u20090.037) and a higher incidence of postoperative complications (adj\n                    <jats:italic>p<\/jats:italic>\n                    value\u2009=\u20090.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4\u00a0years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.\n                  <\/jats:p>","DOI":"10.1007\/s00246-024-03642-2","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T09:43:13Z","timestamp":1726652593000},"page":"1957-1967","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? 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