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

作者：Okonta Kelechi E^*; Agarwal Vijay

来源：Interactive Cardiovascular and Thoracic Surgery, 2012, 14(6): 839-842.

DOI：10.1093/icvts/ivs038

• Sinus node dysfunction
• Warden's procedure
• Partial anomalous pulmonary venous connection
• Cavoatrial junction

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 dysSND) 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.

• 出版日期2012-6