COGNITIVE IMPAIRMENT AFTER CORONARY ARTERY BYPASS GRAFTING: THE ROLE OF MEDICAL REHABILITATION - A LITERATURE REVIEW.

Abstract

Introduction: Advances in cardiac surgery, extracorporeal circulation techniques, and perioperative care have significantly improved survival following coronary artery bypass grafting (CABG). However, the increasing number of postoperative survivors has led to a growing burden of long-term complications, among which cognitive impairment represents a major yet underrecognized clinical problem.

Objective: To critically synthesize current evidence on the prevalence, mechanisms, and clinical significance of cognitive impairment after CABG, as well as to evaluate the role of medical rehabilitation in its prevention and management.

Methods: A structured literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies published within the last five years. Study selection was performed based on predefined inclusion criteria, and elements of the PRISMA framework were applied to enhance transparency. A total of 55 studies were included in the final analysis.

Results: Postoperative cognitive impairment remains one of the most common neurological complications following CABG, affecting approximately 30-60% of patients in the early postoperative period, with persistent deficits observed in a substantial proportion of cases. Its pathogenesis is multifactorial and involves preoperative vulnerability, intraoperative cerebral hypoperfusion and microembolization, systemic inflammation, and postoperative complications. Despite its clinical relevance, cognitive impairment is frequently underdiagnosed and insufficiently addressed within standard rehabilitation programs.

Conclusions: Current rehabilitation models lack systematic approaches to the assessment and management of cognitive dysfunction after CABG. Integrative strategies combining cognitive training, physical rehabilitation, and multimodal interventions demonstrate promising potential for improving cognitive outcomes and quality of life. Further high-quality studies are required to develop standardized rehabilitation protocols with mandatory inclusion of cognitive endpoints.