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.