Which patient is at the highest risk for neurological complications after CABG?

The patient who is 85 years old with an atherosclerotic aorta undergoing cardiopulmonary bypass (CPB) is at the highest risk for neurological complications after coronary artery bypass grafting (CABG). Age is a significant risk factor for neurological events, particularly in older adults, due to age-related vascular changes and a decrease in the body's ability to compensate for ischemic events.

Furthermore, the presence of an atherosclerotic aorta increases the risk of embolic events during CPB, where debris can dislodge and travel to the brain, causing strokes or other neurological impairments. This combination of advanced age and atherosclerotic changes makes this patient particularly vulnerable to complications such as transient ischemic attacks or stroke, which are well-documented risks associated with CABG procedures utilizing CPB.

Other patients, while they may present risks based on individual factors, do not have the same combination of advanced age and a life-threatening vascular pathology that dramatically elevates the likelihood of neurological complications.