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Early And Late Outcomes Of The Warden And Modified Warden Procedure For Right Partial Anomalous Pulmonary Venous Connection
Paul Borchiellini, MD1, Karine Ouellette, B.Sc.1, Yoan Lamarche, MD, M.Sc., FRCSC2, Nadir Tafer, MD3, Bertrand Leobon, MD3, François Roubertie, MD3.
1Université de Montréal, Montréal, QC, Canada, 2Montreal Heart Institute, Montreal, QC, Canada, 3Hôpital Du Haut-Lévêque, Bordeaux, France.
Objective(s): The Warden procedure is an established repair for Partial anomalous pulmonary venous connection (PAPVC), although concerns remain regarding long-term durability and venous thrombosis. This study evaluated outcomes of two Warden procedures across all age groups.
Methods: A retrospective single-center study included all patients undergoing primary Warden procedure between 2009 and 2023. Patients were subdivided into traditional (T-Warden) and modified (M-Warden) groups. Preoperative and operative variables, postoperative outcomes, and follow-up data were reviewed. Primary outcomes included sinus node dysfunction, pulmonary venous thrombosis, and SVC stenosis.
Results: Fifty-two patients underwent repair (median age 16 years, range 11 months-71 years), including 25 T-Warden and 27 M-Warden procedures. Mean follow-up was 6.0±3.4 years with no loss to follow-up. There was no pulmonary venous thrombosis and one late non-cardiac death; actuarial survival was 100% at 1, 2, and 5 years. Early sinus node dysfunction occurred in two patients (3.8%), including one requiring permanent pacemaker implantation. Late SVC stenosis developed in three patients (5.8%), with two requiring reintervention. The modified Warden procedure was not associated with increased thrombosis. All surviving patients were NYHA class I-II at follow-up.
Conclusions: Both Warden procedures provide safe, durable PAPVC repair with excellent long-term outcomes. The modified Warden technique may be particularly suited for adults. Future studies could help develop an algorithm to guide patient-specific technique selection.
Patient Demographics According to Technique | T-Warden (n=25) | M-Warden (n=27) |
| Age (years, mean ± SD) | 18 ± 20 | 28 ± 21 |
| Male gender (n, %) | 15 (29) | 14 (27) |
| Right-Sided Anomalous Pulmonary Veins (n, %) | 11 (21) | 11 (21) |
| Sinus Venosus ASD (n, %) | 24 (46) | 21 (41) |
| Normal sinus rhythm (n, %) | 25 (48) | 25 (48) |
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