The Blalock-Taussig shunt: an analysis of trends and techniques in the fourth decade

The original description of the Blalock-Taussig shunt was published in 1945 and represented the first direct surgical procedure for the treatment of cyanotic congenital heart disease. The present study analyzes the results of Blalock-Taussig shunts performed at Duke University Medical Center during the fourth decade since the original description of the procedure. From 1975 to 1984, 53 classic and 24 modified Blalock-Taussig shunts were performed with a hospital mortality of 8%. These deaths occurred in critically ill patients with either pulmonary atresia or complex congenital cardiac lesions. The results of the early group (1975-1979) were compared to the late group (1980-1984) of patients. There was a greater proportion of infants less than 1 week of age in the late group, and the actuarial event-free shunt survival following operation was significantly better in the late group. This improvement in the late group was apparent both in patients receiving classic and modified Blalock-Taussig shunts and probably represents the effects of advances in microsurgical technique as well as improvement in the support of critically ill infants at the time of surgery by pediatric anesthesiologists and neonatologists. The data in the present study indicate that the mortality associated with Blalock-Taussig shunting is related to the condition of the patient at the time of surgery and the underlying cardiac pathology rather than the age of the patient at the time of shunting. The efforts to further reduce morbidity and mortality associated with Blalock-Taussig shunting should therefore be directed primarily to the support of infants during the preoperative and intraoperative phases of care.