Neurocognitive complications remain a significant challenge following cardiopulmonary bypass (CPB), contributing to increased morbidity and long-term functional impairment. This review aims to summarize the clinical spectrum, underlying mechanisms, and emerging prevention strategies associated with these complications. A structured analysis of recent clinical studies, guidelines, and experimental data was conducted, focusing on neurological outcomes after cardiac surgery. Clinical manifestations range from acute events such as stroke and postoperative delirium to more subtle impairments described as postoperative cognitive dysfunction. Increasing attention has been given to subclinical brain injury, including silent cerebral infarctions, which may contribute to long-term cognitive decline despite the absence of overt neurological symptoms. Current evidence indicates that the pathophysiology is multifactorial. The most consistently supported mechanisms include cerebral microembolization, systemic inflammatory response, and impaired cerebral autoregulation, while other processes such as blood–brain barrier disruption and neurodegenerative changes remain less clearly defined. Despite advances in perioperative care, effective prevention remains challenging due to the complexity and overlap of these mechanisms. Improved understanding of their relative contributions may support the development of targeted strategies to minimize neurological injury. Future research should focus on standardized definitions, improved monitoring, and individualized perioperative management to reduce the burden of neurocognitive complications after CPB.
Januszczak et al. (2026) studied this question.