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Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: Initial clinical experience

https://doi.org/10.1016/j.healun.2013.01.1049Get rights and content

Background

Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH.

Methods

We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent—anchored by the vessel walls and surrounding tissue—serves as the shunt.

Results

TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population.

Conclusions

TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted.

Section snippets

Methods

This study was conducted with institutional oversight provided through an “innovative therapy” framework. This approach ensures patient protection and arms-length review for therapies driven primarily by clinical need and considered too novel to yet conform to a research protocol.

Results

Of 7 patients considered for TPS creation, 4 were catheterized with the intent to perform TPS. TPS creation was performed successfully in 3 patients; in the fourth (our most recent patient), the case was complicated by intrathoracic bleeding, which was fatal. Demographic and procedural data are summarized in Table 1, with additional clinical observations outlined below.

Discussion

Idiopathic PAH has a bleak natural history, and medical intervention remains inadequate.12 Progressive RV failure and/or sudden death may be due to arrhythmia, RV ischemia, or acute RV decompensation with impairment of cardiac output.12, 13, 14 Measures of RV function carry important prognostic significance,12, 13, 14 and altering the RV loading conditions is the ultimate goal of all PAH treatment.

Strategies for management of severe PAH comprise drug therapy, transplantation, and anatomic

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the procedure described in the presented manuscript or other conflicts of interest to disclose.

References (20)

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