Liping Sun, Ning Ma, Xiafeng Yu, Lijun Fu, Yanjun Sun, Hao Zhang, Jijian Zheng, Jie Bai
Shanghai Children’s Medical Center, National Children’s Medical Center and Shanghai Jiao Tong University School of Medicine.
China
Biomedical Central Anesthesiology
BMC Anesthesiol 2026;
DOI: 10.1186/s12871-026-03998-3
Abstract
Background: Pulmonary arterial hypertension (PAH), a life-threatening disorder in children, necessitates palliative interventions like Potts shunt (surgical/transcatheter) for medically refractory cases. Perioperative anesthesia management remains challenging due to hemodynamic instability. This study describes our institutional anesthetic approach and summarizes the perioperative outcomes of 28 pediatric patients who underwent Potts shunt creation.
Methods: A retrospective analysis was conducted on 28 consecutive children who underwent either surgical or transcatheter Potts shunt at Shanghai Children’s Medical Center between 2021 and 2024. Perioperative data were extracted from structured electronic medical records.
Results: Among the 28 patients, 18 underwent surgical Potts shunt creation (100% requiring cardiopulmonary bypass [CPB], median CPB duration: 91[82-108] minutes) and 10 underwent transcatheter procedures (20% requiring CPB). Anesthesia induction predominantly utilized ciprofol-alfentanil (60.7%) and s-ketamine (28.6%). Preoperative treprostinil was universal, with 7.1% of patients requiring additional vasoactive agents. Post-shunt hemodynamic support included norepinephrine (92.9%), dopamine (28.6%) and dobutamine (28.6%). Compared with the transcatheter group, surgical patients experienced significantly longer stays in the cardiac intensive care unit (CICU), (8[7-14] vs. 5[4-9] days, p = 0.005), longer durations of mechanical ventilation (2.5[1.5-10.5] vs. 1.8[1.0-4.3] days), and longer total hospitalizations (31[23-36] vs. 25.5[19-46] days). No intraoperative cardiac arrests occurred. The in-hospital mortality rate was 14.3% (4/28).
Conclusions: Both surgical and transcatheter reverse Potts shunt procedures represent feasible salvage therapies for children with refractory pulmonary hypertension, albeit with considerable perioperative risks. Targeted hemodynamic regulation and rigorous intraoperative emergency management are therefore essential to maintain circulatory stability, prevent pulmonary hypertensive crises, and ensure overall clinical safety.
Category
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Procedural Risk and Care for Individuals with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes