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  • Title: Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children.
    Author: Yong MS, Griffiths S, Robertson T, Brink J, d'Udekem Y, Brizard C, Konstantinov IE.
    Journal: Interact Cardiovasc Thorac Surg; 2018 Sep 01; 27(3):422-426. PubMed ID: 29584855.
    Abstract:
    OBJECTIVES: When drainage of an anomalous pulmonary vein is high into the superior vena cava (SVC), traditional techniques of 1-patch or 2-patch repair may be challenging. The cavoatrial anastomosis technique (the Warden procedure) was developed to reduce the risk of sinus node dysfunction and SVC obstruction. Herein, we describe the outcomes of the Warden procedure in children at a single institution. METHODS: A retrospective study was conducted on all children with partial anomalous pulmonary venous drainage (PAPVD) undergoing the Warden procedure from 1996 to 2015. RESULTS: There were 42 PAPVD patients with a right upper pulmonary vein entering into the SVC undergoing the Warden procedure. The mean age of the patients at surgery was 5.5 years (71 days to 15.4 years). There was no operative mortality. Median hospital stay was 5 (3-25) days. One (2.4%) patient developed cavoatrial (SVC) obstruction. This patient required percutaneous intervention (stenting and balloon dilatation). There was 1 (2.4%) late death in a patient with PAPVD and pulmonary atresia due to a hypoxic brain injury following catheter intervention for a stenotic conduit. Survival was 97 ± 3% (95% confidence interval 83-100%) at 5 and 7 years. All patients were asymptomatic at a mean follow-up of 6 years (range 1 month to 21 years) after surgery. No patient had sick sinus syndrome, sinus node dysfunction or required permanent pacemaker at follow-up. CONCLUSIONS: The Warden procedure for repair of PAPVD to the SVC can be performed with no operative mortality or permanent pacemaker requirement. Mid-term outcomes are excellent with a low occurrence of SVC obstruction.
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