{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:08:24Z","timestamp":1784095704864,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Although most patients with univentricular physiology undergo staged palliation during childhood, a small subset reaches adolescence or adulthood without complete cavopulmonary connection. The role of late total cavopulmonary connection (TCPC) in these patients remains poorly defined. This review summarizes the available evidence regarding TCPC surgery in adolescents and adults and discusses contemporary patient selection. Methods: A structured narrative review of PubMed\/MEDLINE was conducted from database inception to December 2024. Studies reporting primary Fontan or TCPC completion in adolescents and adults were included, whereas studies exclusively addressing Fontan conversion were excluded. The review was conducted according to SANRA recommendations. Results: Sixteen studies reporting outcomes after late TCPC completion were identified. Most adult candidates presented with cyanosis, reduced functional capacity, previous palliation, and dominant left ventricular morphology. Surgical techniques evolved from atriopulmonary connections to lateral tunnel and extracardiac conduit TCPC. Early postoperative mortality ranged from 0% to 20%, with low cardiac output syndrome representing the leading cause of death. Reported survival at 5, 10, and 15 years ranged from 76 to 95%, 71\u201381%, and 66\u201379%, respectively. Preserved ventricular function, low pulmonary vascular resistance, and absence of significant atrioventricular valve regurgitation were consistently associated with better outcomes. Conclusions: Late TCPC surgery in carefully selected adults is feasible and may improve oxygenation and functional status. Contemporary decision-making should integrate anatomical, hemodynamic, functional, rhythm, and end-organ assessment while considering alternative strategies such as transplantation or conservative management.<\/jats:p>","DOI":"10.3390\/jcdd13070333","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:39:38Z","timestamp":1784093978000},"page":"333","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late Total Cavopulmonary Connection in Adolescents and Adults: Narrative Review of Patient Selection and Outcomes"],"prefix":"10.3390","volume":"13","author":[{"given":"Hichem","family":"Sakhi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Imaging, H\u00f4pital Marie Lannelongue, Fondation Paris Saint Joseph, Universit\u00e9 Paris-Saclay, 92350 Le Plessis Robinson, France"},{"name":"Department of Congenital Heart Diseases, Centre de R\u00e9f\u00e9rence Malformations Cardiaques Cong\u00e9nitales Complexes M3C, H\u00f4pital Marie Lannelongue, Fondation Paris Saint Joseph, Universit\u00e9 Paris-Saclay, 92350 Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-0503","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Hasco\u00ebt","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Diseases, Centre de R\u00e9f\u00e9rence Malformations Cardiaques Cong\u00e9nitales Complexes M3C, H\u00f4pital Marie Lannelongue, Fondation Paris Saint Joseph, Universit\u00e9 Paris-Saclay, 92350 Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Belli","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Diseases, Centre de R\u00e9f\u00e9rence Malformations Cardiaques Cong\u00e9nitales Complexes M3C, H\u00f4pital Marie Lannelongue, Fondation Paris Saint Joseph, Universit\u00e9 Paris-Saclay, 92350 Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Diseases, Centre de R\u00e9f\u00e9rence Malformations Cardiaques Cong\u00e9nitales Complexes M3C, H\u00f4pital Marie Lannelongue, Fondation Paris Saint Joseph, Universit\u00e9 Paris-Saclay, 92350 Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1161\/CIRCULATIONAHA.106.627224","article-title":"Congenital Heart Disease in the General Population: Changing Prevalence and Age Distribution","volume":"115","author":"Marelli","year":"2007","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1161\/CIRCULATIONAHA.113.008396","article-title":"Lifetime Prevalence of Congenital Heart Disease in the General Population from 2000 to 2010","volume":"130","author":"Marelli","year":"2014","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.2217\/fca.12.8","article-title":"Changing Lesion Demographics of the Adult with Congenital Heart Disease: An Emerging Population with Complex Needs","volume":"8","author":"Stuart","year":"2012","journal-title":"Future Cardiol."},{"key":"ref_4","first-page":"e698","article-title":"2018 AHA\/ACC Guideline for the Management of Adults with Congenital Heart Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC Guidelines for the Management of Adult Congenital Heart Disease","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur. 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