Favorable Vessel Patency Following Carotid Artery Reconstruction During Extracorporeal Membrane Oxygenation Decannulation in Children With Congenital Heart Disease

BackgroundCarotid artery ligation has been a common practice after extracorporeal membrane oxygenation (ECMO) decannulation due to the risks of embolization, cerebral infarction, aneurysm, and stenosis over time. Carotid artery reconstruction (CAR) after ECMO decannulation is increasingly used, though studies report variable stenosis rates. Data on CAR in children with heart disease, who may require carotid artery patency for future surgery or repeat ECMO, are lacking.ObjectiveTo evaluate carotid artery patency and the incidence of cerebral infarction in pediatric cardiac patients after CAR and ECMO decannulation.MethodsA retrospective review of children (0-21 years of age) who required venoarterial extracorporeal membrane oxygenation (VA-ECMO) via neck cannulation in the cardiovascular intensive care unit at a quaternary children's hospital (2015-2022) was conducted. Children who underwent CAR and survived to discharge were included.ResultsFifty-three children (ages 2 days to 21 years, median, 2 years of age) met the study criteria. Carotid artery imaging was performed in 25 children (47%), with 84% (21/25) showing unobstructed arteries. Imaging follow-up ranged from two days to four years, with a median of three months. Of 33 children who had post-ECMO head imaging, 11 showed new cerebral infarcts, with 4 of those infarcts diagnosed following transition to ventricular assist device (VAD). Given the variability of timing and modality of head imaging and the significant proportion of patients on a VAD, we are unable to determine the true incidence of new infarcts following CAR.ConclusionCarotid artery reconstruction after VA-ECMO decannulation in children with congenital heart disease shows early favorable vessel patency, but the long-term neurological benefits compared with ligation remain unclear. Further prospective studies are needed to evaluate long-term patency and neurological outcomes.