Effects of carotid artery repair following neonatal extracorporeal membrane oxygenation

Abstract

Between 1 June 1991 and 30 June 1996, 62 neonates were placed on extracorporeal membrane oxygenation (ECMO). In 61 the right carotid artery was cannulated. At the time of decannulation, a decision was made regarding carotid artery repair (CAR) based on the condition of the vessel. Thirty-two patients underwent end-to-end CAR and 29 had artery ligation. There was no difference between groups in gestational age or birth weight, but the ligation group 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 neurologic examination was normal or near-normal in 17 of 19 repair infants and 9 of 16 ligation patients. Two repair infants had slight delays in development, while 3 ligation patients had significant delays. Follow-up US showed 3 grade I changes in the repair group with 1 hydrocephalus. There was 1 grade 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 patency rate was 93%, although 12% of the vessels appeared stenotic. Long-term follow-up confirmed persistent patency. CAR, if technically feasible, should be encouraged following neonatal ECMO therapy.