<p><strong>BACKGROUND: </strong>We sought to characterize short- and long-term outcomes following superior cavopulmonary connection (SCPC) in children eligible for inclusion of antegrade pulmonary blood flow (APBF) in the SCPC circuit, exploring whether maintaining APBF was associated with outcomes.</p>

<p><strong>METHODS: </strong>This was a retrospective cohort study of patients with single ventricle heart disease and APBF who underwent SCPC at our center between 1/1/00 and 9/30/17. Patients were divided into two groups: APBF eliminated (APBF (-)), and APBF maintained (APBF (+)) at the time of SCPC.</p>

<p><strong>RESULTS: </strong>Of 149 patients, 108 (72.5%) were in APBF (-) and 41 (27.5%) were in APBF (+). Of those in APBF (+), 5 (12.2%) subsequently had APBF eliminated after SCPC. Patients in APBF (+) had a higher prevalence of chest tube duration &gt; 10 days and underwent more interventions during the post-SCPC hospitalization (1.9% v. 12%, p=0.008 for both), but had shorter surgical support times at SCPC (p&lt;0.0001). There were no differences in post-SCPC intensive care unit or hospital lengths of stay82 patients (76%) in APBF (-) and 22 patients (54%) in APBF (+) underwent Fontan completion during the study period. Patients in APBF (+) had a greater weight gain from SCPC to Fontan [6.7 (1.8-22) v. 8.15 (4.4-20.6) kg, p=0.012] and a shorter hospital length of stay after Fontan [9 (4-107) v. 7.5 (4-14) days, p=0.044].</p>

<p><strong>CONCLUSIONS: </strong>Short term morbidity associated with maintaining APBF at the time of SCPC is modest, but longer-term outcomes suggest potential benefits in those in whom APBF can be successfully maintained.</p>