Outcomes of the Warden Procedure for Partial Anomalous Pulmonary Venous Connection: A New Idea From a Single-Center Experience

Background: Partial anomalous pulmonary venous connection (PAPVC) is prevalently right-sided. The Warden procedure (WP) is performed for the repair of PAPVC when the anomalous right-sided pulmonary veins (PVs) connect to the superior vena cava (SVC) far from the SVC-right atrium (RA) junction. We aimed to describe the mid-term outcomes in the WP. Moreover, we compared the outcomes in double-SVC cases with those without left-sided superior vena cava (LSVC). Methods: In this retrospective study, the medical records of 25 (52% female) patients who underwent the WP between 2009 and 2019 were evaluated. Baseline, perioperative, and follow-up data, including mortality, SVC and PV obstruction, the presence of single right-sided or double SVC, and sinoatrial (SA) node dysfunction, were recorded. Results: The mean (+/- SD) follow-up time was 5.08 years (+/- 2.59 y). No mortality, SVC or PV obstruction, and SA node dysfunction were noted. SVC-RA anastomotic site mild stenosis occurred in 2 patients. Fourteen of the 25 patients (56%) had double SVC. Subgroup analysis of 2 groups of LSVC positive and LSVC negative revealed mild SVC anastomosis site stenosis in 1/14 (7%) of LSVC-positive and 1/11 (9%) of LSVC-negative patients (P=1.00). SVC anastomotic site patch augmentation was necessary in 3 of the 14 (21%) cases of the LSVC-positive group and none of the LSVC-negative patients (P=0.23). Conclusions: The WP was associated with satisfactory outcomes. This method is excellent in patients who have concurrent LSVC. Coincident double SVC anatomy could be a new indication for performing the WP in relatively high PAPVC.