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The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases
Hesham Alkady1, Ahmed Elnaggar1, Mahmoud Eldegwy1
1Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt.
Insights
The Warden procedure safely repairs high partial anomalous pulmonary venous connections (PAPVCs) in children, showing excellent long-term outcomes with minimal complications. This surgical technique is effective for pediatric patients with this congenital heart defect.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Repair
- Thoracic Surgery Innovations
Background:
- Partial anomalous pulmonary venous connections (PAPVCs) are congenital heart defects where pulmonary veins connect to the right atrium or systemic veins.
- High PAPVCs, draining superiorly into the superior caval vein, present unique surgical challenges.
- The Warden procedure offers a specific approach to correct these anomalies.
Purpose of the Study:
- To evaluate the safety and efficacy of the Warden procedure for repairing high PAPVCs in pediatric patients.
- To assess the long-term outcomes and complication rates associated with this surgical technique.
- To share institutional experience with 65 pediatric cases over a decade.
Main Methods:
- A retrospective review of 65 pediatric patients who underwent the Warden procedure for high PAPVCs between January 2010 and January 2020.
- Data collection included patient demographics, operative times, postoperative outcomes, and long-term follow-up.
- Analysis focused on in-hospital mortality, complications, and late outcomes.
Main Results:
- The study included 65 pediatric patients (52.3% male), with a mean age of 3.47 years.
- Mean bypass and cross-clamp times were 84.2 and 54.8 minutes, respectively.
- No in-hospital mortality or permanent pacemaker implantation was observed. Follow-up in 95% of patients revealed no stenosis at the anastomosis site and only one late non-cardiac death.
Conclusions:
- The Warden procedure is a safe and effective surgical option for correcting high PAPVCs in the pediatric population.
- This technique demonstrates good long-term results with a low incidence of significant complications, including sinus node dysfunction and venous obstruction.
- The study supports the Warden procedure as a reliable method for managing this specific type of congenital heart anomaly.
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.
