Two thousand Blalock-Taussig shunts: a six-decade experience.

BACKGROUND

The Blalock-Taussig shunt (BTS) remains valuable for palliation of congenital heart disease, but its role has evolved. We reviewed our total institutional experience with BTS to examine changes in its use and outcomes.

METHODS

A retrospective review was performed of all patients undergoing BTS at our institution from November 1944 to May 2006. Hospital records and autopsy records were evaluated to determine patient demographics, diagnoses, operative data, hospital complications, and long-term outcomes.

RESULTS

During the last 62 years, 2,016 BTS were performed by 28 surgeons on 1,880 patients from 35 countries. Classic BTS were performed in 75% (1,503 of 2,016 BTS). Diagnosis was tetralogy of Fallot in 72% (1,294 of 1,802), although diagnoses were imprecise in the early part of the series. Overall operative mortality was 14% (227 of 1,574). On follow-up, 32% of tetralogy of Fallot patients (411 of 1,294 patients) underwent subsequent total correction at our institution, and an additional 116 patients for whom follow-up was available had total correction of tetralogy of Fallot at other institutions, a combined total correction of tetralogy of Fallot rate of 41%. Of patients with complex congenital heart defects, 26% (106 of 404 patients) had subsequent cavopulmonary connection or atrial or arterial switch procedures. A comparison of the first and second halves of the series revealed several trends: decreasing mean annual number of BTS (66/year versus 9/year, respectively), decreasing operative mortality (16% versus 9%), and increasing proportion of single-ventricle diagnoses (5% versus 34%).

CONCLUSIONS

Evolution of the BTS has seen a decrease in overall use, particularly in tetralogy of Fallot, but greater application to single-ventricle cardiac lesions and improved operative survival.