Early outcomes of reversed potts shunt in pediatric pulmonary arterial hypertension

Background Pediatric pulmonary arterial hypertension carries a poor prognosis. Reversed Potts shunt has been proposed as a bridge from medical therapy to lung transplantation, yet evidence supporting its ability to preserve right ventricular function and improve symptoms in this population remains limited. Method Pediatric patients diagnosed with pulmonary artery hypertension (WHO Group I) and underwent the reversed Potts shunt procedure at Fuwai Hospital between January 2024 and December 2025 were retrospectively reviewed. The study thoroughly summarized the baseline, operative, and outcome characteristics of these patients. All-cause mortality was defined as the primary outcome. Secondary outcomes included echo-evaluated right ventricular function, pulmonary artery pressure, 6-minute walk distance (age over eight), and plasma NT-pro BNP levels. Sensitivity group of patients underwent elective reversed Potts and isolated Potts were beforehand extorted. Results A total of seven pediatric patients classified as intermediate–high or high risk by the ESC simplified risk stratification were included; six underwent elective reversed Potts shunt and one underwent salvage reversed Potts shunt. Two patients had concomitant mitral valve disease and underwent simultaneous mitral valve intervention (repair or mechanical replacement). Most procedures were performed via left thoracotomy, except for two cases via median sternotomy due to concomitant mitral valve surgery. Shunt diameter (median 7.0 mm, IQR 6.5–7.5) was selected according to the descending aortic diameter at the diaphragmatic level (median 12.1 mm, IQR 11.18–12.88). The salvage case, performed after prior mitral valve repair with concomitant valved homograft right ventricular outflow tract reconstruction, resulted in in-hospital mortality. Among the remaining patients, postoperative recovery was uneventful; one late death occurred due to recurrent pulmonary crisis. No consistent improvement was observed in echocardiographic right ventricular function or pulmonary artery pressure. Nevertheless, during a median follow-up of 9.9 months, our data suggested reductions in NT-pro BNP and increases in 6-minute walk distance. Conclusion Our prior study suggest that the reversed Potts shunt may not halt progression of pulmonary arterial hypertension and right heart declination, but may provide symptomatic improvement in selected patients, warranting confirmation in larger cohorts.