NEUROCOGNITIVE COMPLICATIONS AFTER CARDIOPULMONARY BYPASS: COMPLICATIONS, RISK FACTORS AND PREVENTION STRATEGIES – A COMPREHENSIVE REVIEW

Radosław Januszczak; Julianna  Cholewa; Agnieszka Barbara  Białek; Wiktoria  Bojarska; Gabriela Anna  Gilarska; Bartosz  Burda; Rafał  Gołacki; Konrad  Borkowski; Maja  Sygacz; Paweł  Szymonek

doi:10.31435/ijitss.2(50).2026.5439

Authors

Radosław Januszczak University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0007-4088-8138
Julianna Cholewa Human Anatomy Research Group, Medical University of Lublin, Lublin, Poland https://orcid.org/0009-0007-2432-1828
Agnieszka Barbara Białek Faculty of Medicine, Medical University of Lublin, Lublin, Poland https://orcid.org/0009-0004-0855-7732
Wiktoria Bojarska University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0008-6923-2068
Gabriela Anna Gilarska Faculty of Medicine, Medical University of Lublin, Lublin, Poland https://orcid.org/0009-0004-4818-8070
Bartosz Burda University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0002-1871-424X
Rafał Gołacki University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0002-0562-4480
Konrad Borkowski University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0006-2704-1752
Maja Sygacz University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0006-8689-8975
Paweł Szymonek Independent Public Health Care Centre in Lubartów, Lubartów, Poland https://orcid.org/0009-0002-6345-7721

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5439

Keywords:

Cardiopulmonary Bypass, Cardiac Surgery, Extracorporeal Circulation, Postoperative Complications, Risk Factors, Prevention Strategies

Abstract

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.

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