Potts-shunt for the Treatment of Pediatric Patients With Severe Pulmonary Hypertension

May 23, 2024 updated by: China National Center for Cardiovascular Diseases

Multicenter, Prospective, and Exploratory Study of Potts-shunt for the Treatment of Pediatric Patients With Severe Pulmonary Hypertension

This is a multi-center, perspective, and exploratory study aimed at evaluating the 3-years clinical outcome of Potts-shunt procedure for pediatric patients with severe pulmonary artery hypertension (PAH). The included criteria are as followed: 1)6 months < age ≤ 18 years; 2) ESC 2022 Group I PAH; 3) Have received standardized drug therapy for at least 6-9 months and still remain at intermediate to high/high-risk status of the criteria of ESC2022; 4) Presenting with significant clinical manifestations (i.e., progressive symptoms/syncope history/growth and development restriction, etc); 5) Informed consent form signed by the patient and their guardian. The excluded criteria are as followed: 1) ESC 2022 Group II-V PAH; 2) Poor right ventricular function: RVEF < 25% or RVFAC < 20%; 3) Deteriorated general condition: requiring ICU resuscitation or ECMO assistance; 4) Pulmonary artery pressure/main arterial pressure ratio < 0.7; 5) Six-minute walk distance < 150 meters (only applicable to patients aged 8 and above); 6) No significant improvement in RVEF under triple drug therapy. All of the pediatric patients with severe PAH who attend to pediatric cardiac outpatient clinic and meet the designed included criteria and excluded criteria will be enrolled in this study. All of the participants will be divided into two groups (Potts-shunt combined with conventional drug therapy group and only conventional drug therapy group) according to their individual health status (i.e., some contraindications of surgery) and their (or their parents') aspiration for Potts-shunts procedure. Follow-up is designed (eight-times follow-up) at the time of Potts-shunt procedure, post-operative ICU period, one month, three months, six months, one year, two years, and three years after Potts-shunt procedure or the rejection of Potts-shunt procedure. The items of follow-up include state of survival, whether or not have the lung transplantation (LTx), clinical manifestation, laboratory examination, function of right ventricle (detected by echocardiogram and cardiac magnetic resonance imaging), and the pulmonary circulation pressure (detected by right heart catheterization or Swan-Ganz catheterization). Primary outcome is the incidence rates of death or LTx three-years after Potts-shunt. Secondary outcomes are as followed: 1) Number and incidence rate of postoperative complications in patients undergoing Potts-shunt procedure; 2) Three-year WHO cardiac functional and 6-minute walk distance after Potts-shunt procedure; 3) the NT-ProBNP levels three-years after Potts-shunt procedure; 4) Right ventricular function on echocardiography three years after Potts-shunt procedure; 5) Right ventricular function on cardiac magnetic resonance imaging three years after Potts-shunt procedure; 6) Pulmonary circulation pressure measured by right heart catheterization or Swan-Ganz catheterization three years after Potts-shunt procedure; 7) Three-year mortality or LTx incidence rates after only conventional drug therapy.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • China
    • Beijing
      • Beijing, Beijing, China, 100037
        • Recruiting
        • Pediatric cardic surgical center, Fuwai Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. 6 months < age ≤ 18 years;
  2. ESC 2022 Group I PAH;
  3. Have received standardized drug therapy for at least 6-9 months and still remain at intermediate to high/high-risk status of the criteria of ESC2022;
  4. Presenting with significant clinical manifestations (i.e., progressive symptoms/syncope history/growth and development restriction, etc);
  5. Informed consent form signed by the patient and their guardian.

Exclusion Criteria:

  1. ESC 2022 Group II-V PAH;
  2. Poor right ventricular function: RVEF < 25% or RVFAC < 20%;
  3. Deteriorated general condition: requiring ICU resuscitation or ECMO assistance;
  4. Pulmonary artery pressure/main arterial pressure ratio < 0.7;
  5. Six-minute walk distance < 150 meters (only applicable to patients aged 8 and above);
  6. No significant improvement in RVEF under triple drug therapy.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Potts-shunt combined with conventional drug therapy group
The comprehensive therapy included Potts-shunt procedure and conventional drug therapy (i.e., Prostacyclin analogues, PDE-5 inhibitors, and Endothelin receptor antagonists)
Procedure: Comprehensive therapy combined Potts-shunt procedure and conventional drug therapy
Potts-shunt procedure is the surgery that connect the descending aorta and the left/main pulmonary artery by direct anastomosis, a Gore-tex tube or a Gore-tex tube with flap.
Active Comparator: Only conventional drug therapy group
Only admitted with conventional drug therapy (i.e., Prostacyclin analogues, PDE-5 inhibitors, and Endothelin receptor antagonists)
Drug: Only conventional drug therapy
Only conventional drug therapy (i.e., Prostacyclin analogues, PDE-5 inhibitors, and Endothelin receptor antagonists)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality or Lung transplantation
Time Frame: From the date of enrollment until the date of dear from any cause or lung transplantation, which ever came first, accessed up to 3 years
The incidence rates of death or lung transplantation 3 years after Potts-shunt, accessed by in-patient, out-patient, or telephone follow-up
From the date of enrollment until the date of dear from any cause or lung transplantation, which ever came first, accessed up to 3 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number and incidence rate of postoperative complications in patients undergoing Potts-shunt procedure
Time Frame: From the date of enrollment to the date of any postoperative complications, whichever came first, accessed up to 3 years
Postoperative complications include hemoptysis, syncope, pulmonary hypertension crisis, low blood oxygen in the lower extremities etc. accessed by pediatric ICU doctors.
From the date of enrollment to the date of any postoperative complications, whichever came first, accessed up to 3 years
World Health Organization functional class (WHO-FC) after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
WHO-FC was designed to measure the severity of pulmonary hypertension based on symptoms of dyspnea, fatigue, chest pain, and related syncope, accessed by the pediatric doctors.
From the date of enrollment to the date of every view-point, assessed up to 3 years
NT-ProBNP levels after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
NT-ProBNP (pg/ml) accessed by laboratory test
From the date of enrollment to the date of every view-point, assessed up to 3 years
Right ventricular function on cardiac magnetic resonance imaging after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
The RVEF (%) accessed by cardiac MRI
From the date of enrollment to the date of every view-point, assessed up to 3 years
Right ventricular function on echocardiography after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
The RVFAC (%) accessed by echocardiography
From the date of enrollment to the date of every view-point, assessed up to 3 years
Pulmonary circulation pressure measured by right heart catheterization or Swan-Ganz catheterization after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
SPAP, DPAP, MPAP (mmHg) etc. accessed by right heart catheterization or Swan-Ganz catheterization
From the date of enrollment to the date of every view-point, assessed up to 3 years
Mortality or lung transplantation incidence rates after only conventional drug therapy
Time Frame: From the date of enrollment until the date of dear from any cause or lung transplantation, which ever came first, accessed up to 3 years
The incidence rates of death or lung transplantation 3 years after enrollment
From the date of enrollment until the date of dear from any cause or lung transplantation, which ever came first, accessed up to 3 years
The 6-minutes distance after Potts-shunt procedure
Time Frame: From the date of enrollment to the date of every view-point, assessed up to 3 years
The 6-minutes distance (meter) was designed to measure activity tolerance, accessed by pediatric doctors or parents of participants.
From the date of enrollment to the date of every view-point, assessed up to 3 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

China National Center for Cardiovascular Diseases

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 23, 2024

Primary Completion (Estimated)

April 23, 2029

Study Completion (Estimated)

April 23, 2029

Study Registration Dates

First Submitted

May 5, 2024

First Submitted That Met QC Criteria

May 23, 2024

First Posted (Actual)

May 28, 2024

Study Record Updates

Last Update Posted (Actual)

May 28, 2024

Last Update Submitted That Met QC Criteria

May 23, 2024

Last Verified

April 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NCRC2024001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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