Perioperative anesthetic management in pediatric patients with medically refractory pulmonary arterial hypertension undergoing surgical or transcatheter potts shunt: a retrospective case series.
Potts shunt for refractory pediatric pulmonary hypertension carries substantial in-hospital mortality risk.
Perioperative anesthetic management in pediatric patients with medically refractory pulmonary arterial hypertension undergoing surgical or transcatheter potts shunt: a retrospective case series.
Pulmonary arterial hypertension (pulmonary arterial hypertension), a life-threatening disorder in children, necessitates palliative interventions like Potts shunt (surgical/transcatheter) for medically refractory cases.
This study describes our institutional anesthetic approach and summarizes the perioperative outcomes of 28 pediatric patients who underwent Potts shunt creation.
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.
About 1 in 7 children died in hospital after Potts shunt surgery.
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%).
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.