Strategies to protect the brain during cardiac surgery

Despite significant advances in cardiopulmonary bypass (CPB) technology, surgical techniques, and anesthetic management, central nervous system (CNS) complications remain a common and costly problem after CPB. Stroke is often considered a rare and unpreventable complication of cardiac surgery. Recent studies have shown that through the use of echocardiography and historical risk stratification strategies, we can define which patients are at substantially greater risk for CNS injury. Through enhanced understanding of the etiology of stroke and perioperative factors, which ere associated with potential for neuroprotecton or injury extension, there now exists a greater potential than ever to substantially reduce neurological injury associated with cardiac surgery. Strategies and theories of stratifying patients at risk and secondarily reducing that risk are described, as well as consideration for early postoperative assessment to allow treatment when events occur. (C) 2000 by W. B. Saunders Company.