Pathophysiological Basis of CNS Injury in Cardiac Surgical Patients: Detection and Prevention

The current understanding of adverse central nervous system (CNS) events following cardiac surgery involves several identifiable, evidence-based mechanisms: atherosclerotic emboli, microgaseous and microparticulate emboli, and hypoperfusion. Secondary factors, including patient co-morbidities and inherent genetic susceptibilities, as well as systemic inflammatory processes and a suboptimal metabolic milieu may interact to potentiate the extent of injury. In this review a number of these factors and their potential interactions will be explored with a view towards developing a comprehensive management strategy to minimize CNS injury.