Effects of carotid artery repair following neonatal extracorporeal membrane oxygenation

Between 1 June 1991 and 30 June 1996, 62 neonates were placed on extracorpo real membrane oxygenation (ECMO). In 61 the right carotid artery was cannul ated. At the time of decannulation, a decision was made regarding carotid a rtery repair (CAR) based on the condition of the vessel. Thirty-two patient s underwent end-to-end CAR and 29 had artery ligation. There was no differe nce between groups in gestational age or birth weight, but the ligation gro up contained 11 patients with congenital diaphragmatic hernia, compared to 2 in the repair group. The time on ECMO was 148 h for the repair group and 297 h in the ligation group. Follow-up contrast-enhanced magnetic resonance imaging (MRI) studies and ultrasound (US) demonstrated 2 occluded vessels in the repair group (7%); 3 vessels appeared stenotic on MRI. Follow-up neu rologic examination was normal or near-normal in 17 of 19 repair infants an d 9 of 16 ligation patients. Two repair infants had slight delays in develo pment, while 3 ligation patients had significant delays. Follow-up US showe d 3 grade I changes in the repair group with 1 hydrocephalus. There was 1 g rade I and 1 grade III change in the ligation group. Follow-up MRI showed 6 minimal changes in the repair group and 9 in the ligation group. CAR does not adversely affect neurologic outcome after neonatal ECMO. The early pate ncy rate was 93%, although 12% of the vessels appeared stenotic. Long-term follow-up confirmed persistent patency. CAR, if technically feasible, shoul d be encouraged following neonatal ECMO therapy.