Background: Cardiopulmonary bypass (CPB) remains a cornerstone of modern cardiac surgery, enabling complex procedures under controlled physiological conditions. However, its use is associated with a risk of neurological complications, including ischemic and hemorrhagic stroke, cognitive impairment, and delirium. Identifying and mitigating these risks is essential to improve patient outcomes.

Objective: This study aims to assess the key preoperative, intraoperative, and postoperative risk factors contributing to the development of neurological complications in patients undergoing cardiac surgery with CPB.

Methods: A comprehensive review of recent clinical data was conducted, focusing on age-related vascular changes, preexisting comorbidities (hypertension, diabetes, atherosclerosis), duration of CPB, cerebral hypoperfusion, embolic events, and the effects of pharmacologic agents such as beta-blockers, heparin, and insulin. The neuroprotective potential of hypothermia and its adverse effects during rewarming were also analyzed.

Results: Advanced age (>70 years), prolonged CPB time (>120 minutes), hemodynamic instability, and high comorbidity index were strongly associated with neurological complications. Pharmacologic interventions showed both protective and adverse effects, depending on timing and patient-specific factors. The role of intraoperative cerebral perfusion and temperature regulation emerged as critical in reducing neurologic morbidity.

Conclusion: Neurological complications following CPB remain a significant concern in cardiac surgery. A multidisciplinary approach involving careful preoperative assessment, intraoperative monitoring, and targeted pharmacological strategies is crucial for risk reduction and improved neurological outcomes.

Cardiopulmonary bypass, cardiac surgery, neurological complications

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