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To reduce the incidence of neurological and neuropsychological dysfunction following hypothermic cardiopulmonary bypass (CPB), central nervous system (CNS) monitoring before, during, and after CPB seems to be necessary. Compared to the total scope of hemodynamic monitoring CNS monitoring, however, is mostly investigational and infrequently used in clinical routine, and the impact on postoperative outcome is still being discussed. An optimal CNS monitoring would have to include continuous objective measurement of brain function, perfusion, and metabolism with regard to patients' disease and would also have to be adapted to the technique applied and the period of CPB. Over the past few years a number of monitoring devices (computer-processed electroencephalogram, jugular bulb saturation, Doppler flow measurement, near infrared spectroscopy) have been evaluated. Each of them has a specific diagnostic power so that a combination of only two or more devices will meet the criteria for effective brain monitoring. In addition, the impact on outcome and the applicability and cost-effectiveness of these tools will have to be investigated in the future.

Myocardial injury from failed percutaneous transluminal coronary angioplasty (PTCA) is an infrequent but serious complication presenting a spectrum from anginal pain alone to severe transmural myocardial infarction with hypotension, shock, and cardiac arrest. Prevention of myocardial necrosis and preservation of left ventricular function requires immediate restoration of coronary artery blood flow. With patients refractory to medical therapy, urgent emergency myocardial revascularization is the accepted therapy of this complication.