Neurological damage related to cardiac surgery: pathophysiology, diagnostic tools and prevention strategies. Using actual knowledge for planning the future.

Even in milder cases, neurologic complications related to cardiac surgery increase mortality, hospitalization time, and rehabilitation costs, and so contribute to the decrease in quality of life. The incidence of neurologic complications has remained unchanged during the last years, despite age and comorbidity increasing. Improvement in technical approaches has probably contributed to maintain these percentages. Although most of the complications may be related to cardiopulmonary bypass, others factors are also involved. Identifying high risk patients could reduce incidence of complications within high risk groups, but this is probably an insufficient preventive strategy. In a population progressively older and presumably affected by an increasing number of diseases, preventive strategies should be focused on 3 aspects: first, technical improvements in cardiac surgery and cerebral protection; second, pharmacologic therapy; and, finally, identification of reliable techniques to evaluate neuropsychological dysfunction after cardiac surgery. Future efforts will be necessary to identify surrogate markers of neurologic damage and its functional outcome, perhaps related to genetic susceptibility.Only with all of these instruments, really effective preventive or palliative strategies could be planned and applied.