1. Introduction
Neurologic injury is a devastating complication of cardiovascular procedures with a tremendous impact on patients in both the short- and long-term. The incidence of neurologic events after isolated coronary artery bypass grafting (CABG) varies from 1% to 5% (1–2), with older age and increased atherosclerotic burden representing important risk factors. Most perioperative strokes after coronary surgery are ischemic in nature with atheroembolic events due to aortic cannulation and cross-clamping playing a major role (3-16). The importance of a versatile approach employing “aortic-no-touch” strategies has been strongly emphasized in a recent Scientific Statement of the American Heart Association (16). Avoiding aortic manipulation with “anaortic” techniques (anaortic off-pump coronary bypass grafting, anOPCAB) significantly reduces the risk of cerebrovascular events (17-26).
This review will examine how neurologic injury has influenced the current coronary revascularization guidelines, the mechanisms of neurologic injury post-surgery and the evidence related to surgical techniques designed to reduce aortic manipulation and subsequent neurologic risk.