The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping

Abstract

Currently, minimally invasive cardiac surgery has found widespread use even in congenital heart surgery. The number of defects, which can be corrected through a small incision or totally endoscopic, is on the rise. Nowadays, surgeons can repair atrial septal defect, ventricular septal defect, patent ductus arteriosus and other congenital heart defects using minimally invasive techniques. In this paper, we report 21 cases of successful repair of supracardiac partial anomalous right upper and middle pulmonary venous connection, using the Warden procedure. It was performed in children through the right-sided midaxillary thoracotomy with direct cardiopulmonary bypass cannulation and induction of ventricular fibrillation. There were no operative or early postoperative deaths or complications. All patients were in sinus rhythm at discharge. According to echocardiography, there were no cases of early SVC or pulmonary veins narrowing. The Warden procedure can be performed safely and efficiently using the minimally invasive cardiac surgery.

Outcomes of Double-patch and Warden Techniques in Patients With Supracardiac Partial Anomalous Pulmonary Venous Connection

“…Iyer et al [5] compared single-patch and double-patch methods and revealed that the single-patch technique carried a higher risk of SVC stenosis. The results for the Warden procedure and its modifications have demonstrated a low rate of SVC obstruction, despite being a more complicated technique, which, in some cases, has necessitated enlargement of the anastomosis with a patch [2,3,8,10]. All authors emphasise the importance of wide cavoatrial anastomosis and careful resection of all intra-atrial trabeculations, which can cause future stenosis.…”

“…For the surgical approach, besides median sternotomy (23 patients in the DP and 21 in the WP group), right mid-axillary thoracotomy was also used in some patients from both groups (17 in the DP and 19 in the WP group) [10][11][12]. The choice of approach was based on the surgeon's preference.…”

“…Another surgical technique, which was originally described by Lewis in 1958 and later popularised by Warden et al, involves baffling the SVC ostium to the LA through the ASD, with dividing and reimplanting the cranial SVC stump into the right atrial appendage (RAA) (Warden procedure, cavoatrial anastomosis) [6,7]. According to the literature, this procedure can prevent sinus node trauma, reduce arrythmogenic effects, is associated with SND absence at follow-up, and can reduce the risk of SVC and PV stenosis [8][9][10]. This study compared outcomes of correcting PARPVC to the SVC with the double-patch (DP) method and Warden procedure (WP).…”

Totally Endoscopic Robotic‐Assisted Cardiac Surgery in Children

“…Nevertheless, thoracoscopic cardiac surgery has been performed safely as a minimally invasive approach in larger children (15)(16)(17). The feasibility and safety of robotic cardiac surgery under cardiopulmonary bypass has remained limited in children due to technical limitations (7)(8)(9)(10)(18)(19)(20)(21)(22)(23). With the use of new generation systems, totally endoscopic robotic surgery can be a less invasive alternative to the other approaches in selected children with a suitable anatomy and cardiac pathology.…”

Sinus Node Dysfunction In Patients With Supracardiac Partial Anomalous Pulmonary Venous Connection: A Prospective Randomized Study

“…Так, по результатам различ-ных исследований, частота ДСУ после процеду-ры Вардена составляет от 0 до 6,2% [7][8][9][10][11].…”