Abstract
Bi-ventricular congenital heart disease with pulmonary hypertension may be inoperable. Several clinical features suggest operability, but the definitive method for determining operability is the measurement of pulmonary vascular resistance index (PVRI). The "cut-offs" for operability reported in the literature range from 5 to 10.3 Wood Units per m2 (WU·m2). The objective of this study was to identify the optimal PVRI cut-off for operability in congenital heart disease with pulmonary hypertension. A systematic search of Google Scholar and PubMed was conducted from January 1st, 1966, to August 12th, 2024. English-language studies that examined the relationship between preoperative PVRI and operative mortality, as well as long-term post-operative mortality, were included. The study with the highest external validity was selected using the proximal similarity model to determine the optimal PVRI cut-off indicating inoperability. A total of 634 results were retrieved, and eleven full-text papers were examined; two papers were included. PVRI cut-offs ranged from 7 to 10.3 WU·m2. The PVRI cut-off in the most externally valid paper was 10.3 WU·m2. Therefore, the optimal PVRI cut-off indicating inoperability for congenital heart disease with pulmonary hypertension is 10.3 WU·m2, after the administration of 100% inhaled oxygen, referred to as the PVRIO.
Key words: Congenital heart disease, operability, pulmonary vascular resistance index.