Despite the many advances made in cardiac surgery over the
past decades, postoperative brain injury remains a dreaded complication
that could result in excess mortality and medical resource utilization.
Neurologic impairment following cardiac surgery could manifest as a
spectrum, from a serious stroke (type I) to subtle cognitive impairment
(type II). From the standpoint of prevention, embolization and
perioperative cerebral hypoperfusion are the two commonest causes of
neuropsychologic deterioration following coronary artery bypass
grafting (CABG).1 In this issue of CHEST (see
page 25), Bowles and colleagues suggest that avoiding the use of
cardiopulmonary bypass (CPB) could lead to reduced cerebral microemboli
during coronary revascularization, as measured by intraoperative
transcranial Doppler ultrasonography. Considering that CABG
represents more than half the workload in adult cardiac surgery
worldwide, cerebral protection is an important issue that affects our
decision-making process and impacts on our daily practice.