Permanent ligation of the carotid artery remains a major objection to the use of extra corporeal membrane oxygenation (ECMO) in infants with severe cardiorespiratory disorders. Because reconstruction of the carotid artery is highly desirable, we began a study to evaluate the feasibility and risks of carotid artery repair following decannulation. All infants placed on ECMO from December 1988 to January 1990 were evaluated for carotid artery reconstruction. During this period 18 infants underwent carotid reconstruction and 8 infants were deemed unsuitable candidates. Patency of the right common carotid artery was demonstrated in 14 of the 18 infants with good bilateral anterior and middle cerebral artery flow. Seven infants have had MRA evaluation at 6 months and have demonstrated no significant change from their discharge study. These preliminary findings suggest that carotid reconstruction can be performed safely with no apparent morbidity in the majority of infants placed on ECMO, but long-term follow-up data concerning patency rate and neurological status must be obtained before this technique is applied to all infants with this problem.