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Abstract
الملخص
Despite advances in the protection of other end-organs during cardiopulmonary bypass (CPB), brain injury remains a significant and potentially devastating outcome. Neurological injury after cardiac surgery encompasses a wide spectrum of clinical entities ranging from rare fatal cerebral catastrophe to considerably more common psychiatric, neuropsychological and behavioral changes.
A major neurologic complication after otherwise successful surgery represents a devastating outcome for both the patient and the immediate family. The social and economic impact of unemployment and the requirement for long-term rehabilitation or institutional care are significant.
It is well recognized that CPB causes a gross derangement of the normal physiologic and homeostatic mechanisms. The exact cause of CPB- related neurologic injury remains unclear. The main debate over the causative mechanism is between CPB-related hypoperfusion and microvasculature embolization.
The factors thought to contribute to neuropsychologic morbidity include patient age, gender, cerebrovascular disease, diabetes mellitus, cerebral microembolism, duration of cardiopulmonary bypass, temperature and acid-base management.