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Impact of Warden's procedure on the sinus rhythm: our experience
Vijay Agarwal1, Kelechi Emmanuel Okonta, Umar Abubakar
1Department of Cardiac Surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
Objectives:
Our experience with the use of Warden's procedure for the repair of sinus venosus ASD with anomalous right upper pulmonary venous connection.
Method:
Fifty-eight patients had Warden's procedure from September 2008 to May 2011. The demographic data, preoperative and postoperative ECG, aortic cross-clamp time, cardiopulmonary bypass time, Holter monitoring, complications length of ICU and hospital stay were analysed.
Result:
The male to female ratio was 1:1. The median age was 10.9 years (range 2-48 years). Preoperatively all patients were in sinus rhythm. Twenty-six patients had associated left superior vena cava and two patients had also Tucker's procedure at the same time. The mean follow up was 1.2 years (range 1 months-2.8 years). Postoperative Holter monitoring showed sinus rhythm in all the patients. The mean CPB time was 83.6 min (range 54-163 min), mean aortic cross-clamp time was 48.0 min (range 22-112 min), mean ICU stay was 1.26 days (range 1-4 days) and length of hospital was 8.3 days (range 5-13 days) Postoperative echocardiography showed less than 1 mm Hg gradient across the SVC-RA appendage anastomotic site in all the patients. No mortality was recorded.
Conclusion:
This is the largest reported series of Warden's procedure in the literature till date. It is known from other studies that sinus node dysfunction and conversion to junctional nodal rhythm were quite a concern with the conventional techniques and Warden's procedure specifically avoids these problems.
