Reversed valved Potts shunt for refractory primary pulmonary arterial hypertension.

This procedure is carried out via a full sternotomy using standard aortic and bicaval cannulations. For the aortic and pulmonary anastomoses, selective antegrade unilateral cerebral perfusion is used after cooling the body temperature to 26 °Celsius. A 12-mm Hancock conduit is interposed between the pulmonary artery and the proximal descending aorta using standard running suture techniques. Critical decisions during the challenging postoperative management include, but are not limited to, the use of venovenous extracorporeal membrane oxygenation for intermittent support in case of systemic deoxygenation and the anticoagulation and antiplatelet regimen to provide optimal long-term function of the intermittently opening Hancock valve.