Journal of Pediatric Care

Predictors of Mortality in Patients with Isomerism

Background: The so-called heterotaxy, or isomerism, is associated with increased morbidity and mortality. Previous studies have identified various risk factors associated with increased mortality in those with isomerism. The aim of this study was to identify such risk factors in our single center experience.
Methods: Retrospective review of patients cared for at the Children’s Hospital of Wisconsin was carried out to identify patients with isomerism who received care between January 1998 and December 2014. Clinical and surgical data were collected for all these patients. Univariate analysis was conducted to compare characteristics between those who died during this period and those who remained alive. Logistic regression was then conducted to identify independent risk factors for mortality.
Results: We included a total of 83 patients in our analysis. Of these patients, 17 (20%) died during the period of follow-up. The only independent risk factor found to be associated with mortality after logistic regression was the need for extracorporeal membrane oxygenation. Univariate analysis had also identified increased duration of ventilatory support after initial cardiac palliation as associated with mortality, but we did not include this feature in the logistic regression due to the low number of patients.
Conclusion: The need for extracorporeal membrane oxygenation is associated with increased mortality in those with isomerism. No cardiac malformations were identified as independent risk factors of mortality. A larger multicenter effort is required to better identify risk factors associated with mortality in patients with isomerism.

Author(s):

Rohit S Loomba, Peter C Frommelt and Robert H Anderson

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