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Our birthdays tell us how long we have lived, but not necessarily how our bodies are aging. Biological age reflects the condition and function of our cells and tissues, shaped by genetics, lifestyle, environment and disease. In people with chronic conditions such as cancer, kidney disease and heart disease, researchers have observed signs of aging that appear earlier than expected for a person's age. This is known as accelerated biological aging.

In cardiovascular disease, this difference may have important consequences. While accelerated biological aging has been linked to worse outcomes in adults with heart failure, people born with heart defects may also face an increased risk of age-related health problems. These observations raise an important question: Could measuring biological aging help researchers better understand the long-term health of people living with complex heart conditions?

One group for whom this question is particularly relevant is people living with a Fontan circulation. Some children are born with severe heart defects that leave only one functioning pumping chamber, or ventricle, rather than two.

A series of surgeries in early childhood creates a new route for blood flow: Blood returning from the body travels directly to the lungs, without a separate ventricle pumping it there. The single working ventricle then pumps oxygen-rich blood to the body. This arrangement, called Fontan circulation, leaves patients living with a fundamentally different system for moving blood through the heart, lungs and body.

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