Is the patch repair of partial anomalous pulmonary venous drainage equivalent to the Warden procedure?

Introduction: Partial anomalous pulmonary venous return (PAPVR) is a congenital heart defect frequently associated with a sinus venosus atrial septal defect (ASD). Surgical repair varies depending on the anatomical position of the anomalous pulmonary veins. This study aims to compare the outcomes of three surgical techniques - single patch, two-patch technique, and Warden procedure- used in the repair of PAPVR with sinus venosus ASD. Methods: A retrospective study was conducted, analyzing the outcomes of 87 patients who underwent surgical repair for PAPVR between January 2011 and August 2024. Patients were divided into three groups based on the surgical technique used: 44 underwent the Warden procedure, 33 were treated with the single-patch technique, and 10 received the two-patch technique. Results: No mortality was observed across all techniques. The median age at operation was 5.4 years (1.4–10.4 years), and the median hospital stay was 3.0 days (IQR 3.0–4.0). Logistic regression analysis revealed a higher likelihood of immediate postoperative complications with the Warden technique (OR: 5.00, 95% CI [1.30–19.25], p = 0.0193). No patients required a pacemaker implantation. Four patients who had a single (2) and double patch (2) technique needed a reintervention on the systemic or pulmonary venous pathway, while no patient who had a Warden procedure needed a reintervention of the venous pathways. Conclusion: Despite a higher risk of early complications, the Warden procedure seems to preserve patients from reinterventions on the systemic or pulmonary venous pathway.