Objective: We evaluated long-term arterial patency and neurodevelopmental outcome in infants whose right common carotid artery (RCCA) was reconstructed following ECMO.

Methods: Of 70 infants reconstructed between 12/89-9/93, 34 were evaluated for RCCA patency at age 3.5-4.5 years by Doppler ultrasound, and 28 of these were evaluated additionally with extensive neurodevelopmental testing, including the Wechsler Preschool and Primary Scales of Intelligence-Revised Version (IQ) at 5 years. Results of clinical course, MRI's, CT scans and EEG recordings (during the initial hospitalization), and 5 year neurodevelopmental follow-up evaluations (including IQ scores) were compared to those in 35 ligated babies matched retrospectively for diagnosis.

Results: RCCA's were completely patent or less than 50% narrowed(significantly patent) in 26/34 reconstructed children, 3 were significantly stenotic with greater than 50% narrowing, and 5 were completely occluded. There were no significant differences in diagnosis, birth weight, gestation, 5 min Apgar scores, lowest systolic BP or lowest PaO2, or time on ECMO between reconstructed vs ligated infants. There were no significant differences in IQ scores at school age, (verbal 96±18 reconstructed vs 97±17 ligated, performance 95±18 vs 95±11, full scale 95±18 vs 96±13). Four children in each group were retarded (IQ<70, P=1.00). Marked abnormalities(eg infarctions) on CT or MRI scans during hospitalization (4/31vs 11/29, P=.025), and cerebral palsy (CP, 0/34 vs 5/35, P=.054) tended to be more common in ligated infants. No preferential laterality in right vs left brain abnormalities was demonstrated in any hospital or long-term outcome evaluation for either group.

Conclusions: The majority of RCCA repairs were patent at long term follow-up, although a significant minority were significantly stenotic or completely occluded. No developmental advantage was conferred by repair. Significant differences in the occurrences of abnormal brain imaging and/or CP(more common in ligated infants) cannot be attributed to cerebrovascular insufficiency without randomized study.