Transcatheter creation of a Potts shunt with the Occlutech Atrial Flow Regulator: Feasibility in a pig model.

Published on Mar 15, 2021in International Journal of Cardiology3.229
· DOI :10.1016/J.IJCARD.2020.11.008
Sok-Leng Kang5
Estimated H-index: 5
(Boston Children's Hospital),
Juan Contreras2
Estimated H-index: 2
(U of T: University of Toronto),
Rajiv Chaturvedi27
Estimated H-index: 27
(U of T: University of Toronto)
Abstract Background Creation of a Potts shunt, a connection between the left pulmonary artery (LPA) and descending aorta (DAo), improves functional status and survival in drug-refractory suprasystemic pulmonary arterial hypertension. We investigated a new approach to transcatheter Potts shunt creation in pigs. Methods and results In six pigs, a steerable SureFlex sheath was used to optimize the trajectory of perforation from the DAo into LPA using a 0.035″ radiofrequency wire. The combination of a larger perforation, stiffer radiofrequency wire and smooth dilator-to-sheath transition allowed sheath entry into the LPA without requiring an arterio-venous wire circuit. The Occlutech Atrial Flow Regulator (AFR), a double-disc device with a central fenestration, was deployed through this sheath with apposition of the distal disc to the posterior LPA wall and the proximal disc to the anterior DAo wall. The AFR is compliant and crumpling of the central fenestration was resolved by balloon dilation. It was feasible to implant a stent within the fenestration (n = 3). Aortography confirmed a left-to-right shunt through the AFR without contrast extravasation. Autopsy demonstrated anchoring of both discs against the vessel walls, patency of the fenestration and secure placement of the stent with no intra-thoracic bleeding. Conclusions In an acute pig model, we have demonstrated the feasibility of creating a transcatheter Potts shunt with a simplified technique using a steerable sheath, a double-disc device with a central fenestration that acts as the shunt channel and optional stenting of the fenestration.
#1Manish Aggarwal (BCM: Baylor College of Medicine)H-Index: 2
#2R. Mark Grady (WashU: Washington University in St. Louis)H-Index: 21
Last. Gautam K. Singh (WashU: Washington University in St. Louis)H-Index: 26
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Background: Pulmonary arterial hypertension is a progressive disease with poor outcomes in children. Right ventricular (RV) function is the most important determinant of the prognosis. Novel applic...
19 CitationsSource
#1Younes Boudjemline (University of Paris)H-Index: 46
#2Aleksander SizarovH-Index: 6
Last. Damien Bonnet (University of Paris)H-Index: 88
view all 8 authors...
Abstract Background The reversed Potts shunt improves right ventricular (RV) function in patients with suprasystemic pulmonary arterial hypertension (PAH). The proximity of the left pulmonary artery (LPA) to the descending aorta (DAo) permits the creation of a transcatheter connection. We sought to assess the safety, feasibility, and hemodynamic efficacy of the transcatheter Potts shunt (TPS) in children. Methods The TPS procedure was performed using radiofrequency energy for vessel perforation ...
20 CitationsSource
#1Aleksander SizarovH-Index: 6
#2Francesca RaimondiH-Index: 11
Last. Younes Boudjemline (University of Paris)H-Index: 46
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Objective To morphometrically characterise the region of adjacent descending aorta (DAo) and left pulmonary artery (LPA) regarding the transcatheter creation of the reverse Potts shunt. Methods and results Retrospective review of the invasive haemodynamic data and measurements of the vessel diameters, distances and angles based on the thoracic CT of children with idiopathic pulmonary arterial hypertension (PAH) with pulmonary-to-systemic systolic pressure ratio ≥0.5. Forty-eight CT scans from 47...
6 CitationsSource
#2Emre BelliH-Index: 29
Last. Damien Bonnet (Paris V: Paris Descartes University)H-Index: 88
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OBJECTIVES: Palliative Potts shunt has been proposed in children with suprasystemic pulmonary arterial hypertension (PAH). METHODS: A retrospective multicentre study was performed to assess short- and long-term outcomes after Potts shunt. RESULTS: From 2003 to 2014, 24 children underwent a Potts shunt [19 surgical, median age: 7.7 years (1.5–17 years), median weight: 19.5 kg (10.2–47 kg) and 5 transcatheter, median age: 8.1 years (2.3–9.7 years), median weight: 22 kg (12.5–31 kg)] for drug-refra...
91 CitationsSource
#1Jesse J. Esch (Boston Children's Hospital)H-Index: 10
#2Pinak B. ShahH-Index: 18
Last. Audrey C. Marshall (Boston Children's Hospital)H-Index: 42
view all 11 authors...
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 perfor...
89 CitationsSource
Cited By0
#1Sok-Leng Kang (Boston Children's Hospital)H-Index: 5
#2Lee N. Benson (U of T: University of Toronto)H-Index: 74