Abstract: Pulmonary artery hypertension (PAH) is a disease secondary to congenital heart diseases, pulmonary vascular disorders, embolism, or idiopathic reasons. Surgery is necessary for PAH refractory to modern combined medical therapy. Results of lung transplantation are limited by factors like donor shortage, matching difficulty, immune rejection, etc. In order to make an extracardiac shunt to release the deadly right ventricular failure, the old Potts shunt surgery has enjoyed a recent revival. Although some early and mid-term results are satisfactory, the history of Potts shunt surgery in the treatment of refractory PAH is short and the sample size is limited. More proofs of medical research are needed for its specific indications, details of surgical strategies, and long-term prognosis. Based on its origin and development in the treatment of PAH, this paper reviews the advantages, future directions and unsolved key problems of Potts shunt surgery.