Does Warden's procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Does Warden's procedure reduce sinus node dysfunction (SND) after surgery for partial anomalous pulmonary venous connection?' Altogether 101 papers were found using the reported search; of which 10 papers provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, length of follow-up and results of these studies were tabulated. There was a particular reference to Warden's procedure, avoidance of incision across the cavoatrial junction and the postoperative sinus node status. There was a direct reference to the adoption of Warden's procedure in nine studies while one study emphasized the careful use of incision across the cavoatrial junction as a way of averting postoperative SND. The evidence supports the notion that preservation of the sinus node and its blood supply through the adoption of Warden's technique results in near-absent SND during long-term follow-up. The incidence of SND ranged from 0 to 6.5% when Warden's procedure was used, increasing to 18.1% when the atrial incision was extended across the cavoatrial junction into the superior vena cava and reaching as high as 55% in double-patch repair. The study limitations include the lack of randomized controlled trial, absence of 24 h Holter monitoring in most of the patients and shorter periods of follow-up.