Title:Reversed Potts Shunt Outcome in Suprasystemic Pulmonary Arterial
Hypertension: A Systematic Review and Meta-Analysis
Volume: 18
Issue: 6
Author(s): Brian Mendel*, Christianto Christianto, Phoniex Angellia, Indra Holiyono, Radityo Prakoso and Sisca Natalia Siagian
Affiliation:
- Pediatric Cardiology and Congenital Heart Defect Division, Department of Cardiology and Vascular Medicine,
National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
Keywords:
Outcome, pulmonary arterial hypertension, reversed Potts shunt, suprasystemic, PRISMA, pulmonary vascular resistance, pulmonary artery coupling.
Abstract:
Background: Reversed Potts shunt has been a prospective approach to treat suprasystemic
pulmonary hypertension, particularly when medication treatment fails to reduce right ventricular
afterload.
Objective: This meta-analysis aims to review the clinical, laboratory, and hemodynamic parameters
after a reversed Potts shunt in suprasystemic pulmonary hypertension patients.
Methods: Six electronic databases were searched from the date of inception to August 2021, where
the obtained studies were evaluated according to the PRISMA statement. The effects of shunt creation
were evaluated by comparing preprocedural to postprocedural or follow-up parameters, expressed
as a mean difference of 99% confidence interval. Quality assessment was conducted using
the STROBE statement.
Results: Seven studies suited the inclusion criteria which were included in this article. A reduction
in upper and lower limb oxygen saturation [Upper limb: St. Mean difference -0.55, 99% CI -1.25
to 0.15; P=0.04; I2=6%. Lower limb: St. Mean difference –4.45, 99% CI –7.37 to –1.52;
P<0.00001; I2=65%]. Reversed Potts shunt was shown to improve WHO functional class, 6-minute
walk distance, NTpro-BNP level, and hemodynamic parameters including tricuspid annular plane
systolic excursion, interventricular septal curvature, and end-diastolic right ventricle/left ventricle
ratio.
Conclusion: Reversed Potts shunt cannot be said to be relatively safe, although it allows improvement
in the clinical and functional status in patients with suprasystemic PAH. Reversed Potts shunt
procedure may be the last resort for drug-resistant pulmonary hypertension as it is considered a
high-risk procedure performed on patients with extremely poor conditions.
