The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

Abstract

Introduction: In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years. Patients and methods: In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study. Results: In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) could be followed up for a mean period of 7.8 ± 1.2 years after discharge. During the follow-up period, no stenosis was detected in the Warden anastomosis or the rerouted pulmonary veins and only one case of late mortality (1.6%) occurred due to a non-cardiac cause. Conclusion: The Warden procedure is a safe approach for the repair of high PAPVCs (above the cavoatrial junction) in the paediatric age group with good long-term results and low incidence of complications like sinus node dysfunction as well as pulmonary vein and superior caval vein obstruction.

Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review and Meta‐Analysis

“…A total of 141 full‐text articles were retained after the screening of titles and abstracts using the exclusion criteria. Full‐text articles were reviewed, and 39 studies meeting the inclusion criteria were included for qualitative and quantitative synthesis 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 (Table 1 ). According to the Newcastle–Ottawa Scale, no study had a low risk of bias, 39 had moderate risk, and 1 had high risk of bias 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , …”

“…Across 40 studies, 1320 patients underwent SVASD repair. 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Most patients (88.0%) had associated partial anomalous pulmonary venous connection. A persistent left‐sided superior vena cava was the second most common associated lesion found in 79 (20.8%) patients across 7 studies.…”

“…Follow‐up data at 30 days were available for 780 patients across 21 studies, with 4 deaths overall, resulting in a 30‐day mortality rate of 0.5% (Figure 2 ). Long‐term mortality data, including deaths not related to cardiac or operative causes were available in a few studies 6 , 15 , 28 , 29 , 45 , 49 (Table 2 ). At a weighted mean follow‐up of 7 days, the in‐hospital mortality rate was 0.24% (n=3/1242 [95% CI, 0.07%–0.69%]).…”

Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review

“…Follow-up data at 30 days available for 720 patients across 21 studies with 4 deaths overall, resulting in a 30-day mortality of 0.56% (Figure 2). Long-term mortality data, including deaths not related to cardiac or operative causes were available in a few studies 6,14–18 (Table 2). Calculation of pooled incidences for mortality was not statistically feasible, given that a standard correction factor of 0.5 would overestimate the mortality rate.…”

New Insights into Sinus Venosus Defects from Cross-Sectional Imaging

“…When a single or double patch technique is deemed to compromise the pulmonary venous and/or superior vena caval patency or result in sinus node damage, Warden procedure is performed [59]. The Warden procedure consists of transection of the superior vena cava above the level of the anomalous pulmonary venous connection, routing of the transected lower part of the superior vena cava to the left atrium using the sinus venosus defect, and connection of the transected upper part of the superior vena cava to the right atrial appendage [59][60][61].…”