10 - Unsung Innovator: Vivien Thomas and the Surgical Breakthrough That Changed Cardiac Care

Publication Number: 2009.10

Munachiso V.. Mmuo, University of Texas Southwestern Medical School, Lebanon, NH, United States; Paolo I. Amar, University of Texas Southwestern Medical School, RICHARDSON, TX, United States; Ryan M. Mugo, University of Texas Southwestern Medical School, Anna, TX, United States; Marzuq O. Jaiyeola, University of Texas Southwestern Medical School, allen, TX, United States; Ritu R. Trivedi, University of Texas Southwestern Medical School, Dallas, TX, United States; Caitlyn C. Belza, Children's Health, Dallas, TX, United States; Araoluwa Akinfenwa, University of Texas Southwestern Medical School, Anna, TX, United States; Jacob Edwards, University of Texas Southwestern Medical School, Rockwall, TX, United States; Rachel L.. Leon, University of Texas Southwestern Medical School, Dallas, TX, United States; Kikelomo Babata, UTSW, Dallas, TX, United States

Background: Vivien Thomas (1910-1985) was an African American surgical technician who impacted the field of cardiothoracic surgery through his contributions to the Blalock-Taussig-Thomas shunt (BTT shunt), a landmark procedure to treat cyanotic congenital heart disease (CHD). Thomas, son of a carpenter and grandson of a slave, planned to attend medical school after graduating high school with honors. However, due to financial hardship during the Great Depression, he could not pursue his dream of becoming a physician. In 1930, he worked as a laboratory assistant with Dr. Alfred Blalock at Vanderbilt University where he developed a deep understanding of intricate surgical techniques and research methods. Despite performing at the level of a postdoctoral researcher, he was paid and classified as a janitor due to institutional racism of the Jim Crow era.

Objective: To explore the contributions of Vivien Thomas to the development of the BTT shunt, and examine how he broke through racial barriers.

Design/Methods: We used PubMed to find and review medical journal articles, read historical accounts and biographies to understand Thomas' impact on the CHD field.

Results: We found that Thomas was tasked with creating cyanosis in a canine model through surgical restriction of pulmonary blood flow to mimic the physiology of tetralogy of Fallot. He meticulously studied surgical approaches to correct the cyanosis utilizing various shunt techniques, ultimately demonstrating success by creating an anastomosis between the subclavian and pulmonary arteries. Thomas worked for two years and practiced on approximately 200 dogs to demonstrate that the procedure was not lethal. With Thomas' expertise and intraoperative guidance, Drs. Alfred Blalock and Helen Taussig learned to apply the technique for palliation of neonates with cyanotic tetralogy of Fallot. In 1945 the procedure was reported in the Journal of the American Medical Association as the Blalock-Taussig shunt, failing to credit Thomas' pioneering role in creating the surgical technique. In 2003, it was proposed the shunt be renamed the Blalock-Taussig-Thomas shunt.

Conclusion(s): Thomas' work was foundational to the development of the first successful surgical treatment of cyanotic CHD in humans and to the field of congenital cardiothoracic surgery but was unfortunately unrecognized until 2003. Thomas faced significant racial barriers, including low pay and lack of academic recognition. He remained resilient and continued to pursue his passion for medicine. In 1976, he was presented with an Honorary Doctor of Law by Johns Hopkins University.

Unsung Innovator: Vivien Thomas and the Surgical Breakthrough That Changed Neonatal Cardiac Care
Timeline of the life of Vivien Thomas

Vivien Thomas life Timeline (Table)
Vivien Thomas life Timeline (Table)