This week we review a recent important longitudinal follow up study of patients who have undergone palliation for the treatment of HLHS at The Children's Hospital of Philadelphia over the past 35+ years. What are the 'transplant-free' survival numbers at 35 years follow up following newborn palliation? Are there differences between hybrid and traditional "Norwood/Stage I" palliation? What factors explain the group of HLHS patients who do are 'super-Fontan's'? What accounts for the marked variability in outcomes of these complex patients? Dr. J. William Gaynor shares his deep insights both from his large scale paper and long-term experience caring for patients with HLHS.

doi: 10.1016/j.jacc.2025.04.028