Others have suggested that perioperative insults play an important role in the pathophysiology of neurocognitive dysfunction, with potential mechanisms including inflammation, cerebral hypoperfusion, embolic events, and changes in functional connectivity, among others. ![]() ![]() 5 In other words, baseline vulnerability may be the most important consideration in predisposing patients to postoperative neurocognitive decline. 4 In support of this, a recent study found that cognitive trajectories before and after coronary artery bypass graft with cardiopulmonary bypass were similar. A cohort study that used nonsurgical control groups reported that long-term neurocognitive decline after surgery is similar to that of the trajectory seen in nonsurgical controls, emphasizing the importance of the natural progression of underlying brain pathology. 1–3 However, the causal role of cardiac surgery in the development of neurocognitive dysfunction is not clear. ![]() Neurocognitive dysfunction is a common complication of cardiac surgery, affecting between 10 and 40% of patients in the first 1 to 3 months and 5 to 25% of patients at 6 months to 1 yr after cardiac surgery.
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