Summary: This week we explore the question of optimal timing of the Fontan operation. What factors are associated with good or bad outcome after Fontan in regards to age at surgery? Can Fontan palliation have a positive impact on cardiac function? Is there a 'sweet spot' regarding timing of this single ventricle palliation? Who deserves a fenestration? These are amongst the many questions we review this week in our review of a recent large German experience in Fontan in patients with advanced age at Fontan. We discuss the paper and aspects of it with noted surgeon Dr. Ram Kumar Subramanyan, Assistant Professor of Surgery and Pediatrics of USC - Children's LA. DOI: 10.1016/j.jtcvs.2018.03.155
