Cerebral complications in cardiac surgery: changing concepts and technologic advances

Coronary artery bypass surgery is an effective treatment for patients with multivessel coronary artery disease. The overall mortality and cardiac morbidity associated with the procedure has progressively declined since the early days, mostly attributable to improvements in surgical and anesthetic techniques. Over the same period, however, the average age of patients undergoing surgery has risen considerably, and with it, the incidence of neurologic complications. Currently, neurologic complications are the leading cause of morbidity associated with the procedure, and death due to neurologic causes has increased from 7% to 20% of all deaths. These complications are reflected in prolonged hospitalization of patients, at dramatic cost both to the patient and to the health system as a whole.