Okonta Kelechi E, Agarwal Vijay
Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital, Ibadan, Nigeria.
Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):839-42. doi: 10.1093/icvts/ivs038. Epub 2012 Mar 8.
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 dysfunction (SND) 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.
一篇心胸外科最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“在部分性肺静脉异位连接手术中，采用沃登术式是否能减少术后窦房结功能障碍（SND）？”通过报告的检索共找到101篇论文；其中10篇论文提供了回答该问题的最佳证据。将这些研究的作者、期刊、发表日期、国家、研究的患者组、研究类型、相关结果、随访时长及结果制成表格。特别提及了沃登术式、避免跨越腔房交界处切口以及术后窦房结状态。9项研究直接提及采用了沃登术式，而1项研究强调谨慎使用跨越腔房交界处的切口作为避免术后SND的一种方法。证据支持这样一种观点，即通过采用沃登技术保留窦房结及其血供会使长期随访期间的SND几乎不存在。采用沃登术式时SND的发生率为0%至6.5%，当心房切口延伸至跨越腔房交界处进入上腔静脉时，SND发生率增至18.1%，在双补片修复中高达55%。研究局限性包括缺乏随机对照试验、大多数患者未进行24小时动态心电图监测以及随访时间较短。
