Brain injury remains one of the most dreaded complications of cardiac surgery. The range of injury is broad; while a stroke may be easily defined and diagnosed, more subtle injuries most definitely occur. There remains debate as to how these are diagnosed and there is a lack of standard definitions allowing inter-study comparison. If we are to have confidence in strategies that may reduce brain injury, we need to have confidence in the end-points used to define that injury. We need to better understand the phenomena associated with neuropsychometric testing; we need to fully elucidate the relationship between structural brain injury, embolism counting, and surrogate biomarkers; and we need an improved understanding of the clinical significance of abnormalities detected on postoperative magnetic resonance imaging. Brain Protection in Cardiac Surgery presents a detailed background of studies of neurological morbidity and neuroprotection from a range of experts in the field of neuroprotection, providing a detailed reference for clinicians in the field. The Editors have detailed connections between the different strands of injury — be it the pathology, the imaging, the clinical and cognitive examination, potential biomarkers — and have then provided summary reports of treatment strategies that may reduce such injury. As we look to the future, the design of studies attempting to reduce such injury becomes increasingly important and this book provides the fundamental background information to fuel interest, initiate novel prevention and therapeutic strategies, and inform the investigator how to develop and design their research study.

Section 1: The brain injury of cardiac surgery


1.1 Cerebral physiology and metabolism


1.2 The molecular and biochemical basis of brain injury and heart surgery – Interventions for the future


1.3 The cardiopulmonary bypass circuit and the brain


1.4 The neurological sequelae of cardiac surgery


1.5 The incidence, pre-operative risk factors and long-term outcome of subtle brain injury and cardiac surgery


1.6 The neuropathology of brain injury in cardiac surgery


1.7 Inflammatory response and the brain


1.8 The impact of brain injury on post-surgical quality of life




Section 2: The assessment of brain injury


2.1 The utility of neuropsychometric analysis following cardiac surgery


2.2 Pitfalls of neuropsychometric assessment and alternative investigative approaches


2.3 Imaging of the brain in cardiac surgery as a tool in brain protection studies


2.4 Current techniques of emboli detection and their utility in brain protection studies


2.5 Intra-operative brain monitoring in cardiac surgery


2.6 The design of brain protection studies in the 21st century




Section 3: Reducing brain injury in cardiac surgery


3.1 Temperature and brain protection in cardiac surgery


3.2 Studies of non-pharmacological interventions to reduce brain injury


3.3 Pharmacological studies to reduce brain injury following cardiac surgery


3.4 Off-pump and on-pump coronary artery surgery and the brain


3.5 Experimental basis and clinical studies of brain protection in paediatric heart surgery


3.6 Experimental basis and clinical studies of brain protection in aortic arch surgery


Section 4: The future


4.1 The future of brain protection in cardiac surgery