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Published on: February 11, 2017
Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical
Jesse J Esch1, Pinak B Shah, Barbara A Cockrill
1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Transcatheter Potts shunt (TPS) creation offers a feasible palliative option for severe pulmonary arterial hypertension (PAH) patients, potentially improving symptoms. Further research is needed for this innovative treatment approach.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pulmonary Hypertension
Background:
- Severe pulmonary arterial hypertension (PAH) leads to progressive right heart failure, causing significant morbidity and mortality.
- Surgical Potts shunts are used for pediatric PAH palliation, but adult surgical mortality is prohibitively high.
Observation:
- A novel transcatheter Potts shunt (TPS) technique involves creating a tract between the left pulmonary artery and descending aorta via retrograde needle perforation.
- A covered stent is deployed within the tract to establish the shunt, anchored by vessel walls and surrounding tissue.
Findings:
- TPS creation was attempted in 4 of 7 patients, with technical success in 3.
- One patient died during the procedure from hemothorax; another died from comorbidities post-procedure.
- Two mid-term survivors (4 and 10 months) showed symptomatic improvement and no late complications.
Implications:
- Transcatheter Potts shunt creation is a feasible approach for select refractory PAH patients.
- This innovative procedure may provide symptomatic relief in a high-risk population.
- Further investigation into TPS is warranted to establish its role in PAH management.
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.
