Kobayashi Y, et al. - In this retrospective observational study, researchers examined the long-term outcomes in 136 patients who underwent a Norwood procedure with right ventricle–pulmonary artery (RV–PA) conduit for hypoplastic left heart complex between 1998 and 2017. Stage 1 survival of 91.9% (125/136) was observed. Requirement for reintervention for PA stenosis was observed in 22% and 30% at stages 2 and 3, respectively, while there were 15% who underwent reintervention for aortic arch recoarctation. Overall mortality was observed to be related with the following factors: weighing < 2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Outcomes here suggest that under the current surgical strategy incorporating RV–PA Norwood procedure as the first palliation, there was acceptable probabilities of survival and Fontan completion. They emphasize the prime importance of incorporating a strategy to maintain PA growth and ventricular function through the staged repair.