The Brain and Cardiac Surgery. Edited by Stanton P. Newman and Michael J. G. Harrison, with David A. Stump, Peter Smith, and Ken Taylor. Amsterdam, Overseas Publishers Association, 2000. Pages: 351. Price: $112.00 (cloth).

The editors should be congratulated for providing us with a comprehensive review of neurologic complications related to cardiac surgery. Their book is organized into four sections, relating to pathophysiology, monitoring devices and techniques, surgical and perfusion techniques, and a final pair of chapters devoted to cardiac transplantation and circulatory support and correction of congenital heart disease. The 19 topical chapters reflect the main themes of research in this area and are generally authoritative as of the publication date.

The book reflects the strengths and weaknesses of this field’s knowledge base. For example, the multiple scoring criteria that investigators have used to identify adverse neurobehavioral outcomes (typically referred to as “deficits”) result in nearly half of the chapter about that topic being consumed by methodologic considerations. The lack of a consistent definition for a neurobehavioral “deficit” certainly contributes to the latent skepticism that many clinicians have about using the incidence of “deficits” as an outcome measure comparable to stroke, myocardial infarction, or death.

Most chapter authors have been appropriately unwilling to endorse freely the many maneuvers and therapies that have seemed to improve outcome in a single center or in a single clinical trial. This trait was particularly apparent (and welcome) in the chapters about neuroprotection and about hypothermia.

I wish that off-pump coronary artery bypass techniques, with a burgeoning literature about neurobehavioral outcomes, had received greater attention. A chapter detailing how best to design and conduct clinical trials in this area would also have been useful. Nevertheless, I greatly enjoyed this text, and I suspect that all those with an interest in the topic would, after reading it, come to similar conclusions.