Systemic-to-pulmonary artery shunt: a surgical strategy with no expiration date

Background: Systemic-to-pulmonary shunts remain a fundamental surgical option in the palliative management of complex congenital heart defects, particularly in patients with univentricular physiology. Although technically demanding, the procedure has evolved through multiple modifications aimed at simplifying its execution and reducing complications, while maintaining its essential clinical role. Objective: To provide a narrative review of the Blalock-Taussig-Thomas shunt, examining its physiological basis, surgical technique, associated risks and complications, postoperative management, and historical evolution, with the goal of evaluating its continued relevance in the palliative treatment of complex congenital heart defects. Methods: A literature search was conducted in Elsevier, PubMed, and Scopus using the keyword "systemic-to-pulmonary shunt." Studies addressing historical development, technical evolution, clinical indications, and postoperative outcomes were included. The review focused on pediatric populations, specifically prenatal, neonatal, and school-age patients. Studies involving adolescents were excluded to maintain consistency with early developmental stages and the typical clinical context in which these shunts are used. Results & conclusion: The systemic-to-pulmonary shunt remains a valuable and widely used palliative technique for patients with complex congenital heart defects and univentricular physiology. While the original Blalock-Taussig-Thomas technique has historically shown favorable outcomes, differences in complication rates among its variants are influenced by patient selection and institutional experience. Emerging alternatives, such as ductal stenting, may reduce the frequency of surgical shunt placement in selected patients; however, they do not currently replace the systemic-to-pulmonary shunt as a comprehensive or universally applicable strategy.