Brain health measures and prehabilitation in cardiac surgery

Prehabilitation is the optimization of patients prior to surgery to improve postoperative outcomes. Postoperative neurological complications, including stroke, delirium, and postoperative cognitive decline, are commonly reported in patients undergoing cardiac surgery. To risk-stratify and optimize patients prior to cardiac surgery with respect to these complications, various measures of preoperative brain health are utilized in prehabilitation regimens. In this narrative review, we summarize the markers and assessments of brain health that are used to evaluate preoperative brain function, as well as the prehabilitation measures that have shown favorable association with reduction of postoperative neurologic complications. This includes an overview of serum biomarkers, physical therapies, cognitive training, nutritional supplementation, and substance use cessation counseling that are available during cardiac prehabilitation. Neurocognitive outcomes of patients who underwent prehabilitation prior to cardiac surgery are reported. Substance use cessation prior to cardiac surgery is discussed.