Abstract
Despite its lifesaving role, open heart surgery (OHS) is frequently complicated by neurological injury resulting from cerebral ischemia and reperfusion (I/R) injury, systemic inflammation, and unavoidable oxidative stress. These pathological cascades lead to neuronal death and cognitive decline, which highlights the urgent need for adjunctive neuroprotective strategies. Probiotics and phytoantioxidants have emerged as promising candidates because of their ability to modulate gut-brain axis signaling, reduce oxidative stress, and support vascular repair. Probiotics provide benefits by stabilizing intestinal microbiota, lowering systemic endotoxemia, and enhancing anti-inflammatory cytokine activity, thereby indirectly protecting neural tissue. Phytoantioxidants such as polyphenols directly neutralize I/R-induced reactive oxygen species (ROS), which promote microvascular recovery and neuronal survival. Experimental studies demonstrate the effects of probiotics and phytoantioxidants in reducing excitotoxic neuronal injury and improving neurovascular outcomes, while preliminary clinical observations suggest potential cognitive benefits in surgical populations. Nevertheless, cohort evidence remains scarce, and standardized clinical trials are required to establish optimal dosing, bioavailability, and long-term efficacy. This review emphasizes the translational potential of probiotics and phytoantioxidants as complementary interventions to mitigate brain injury after OHS, addressing a critical therapeutic gap in perioperative neuroprotection.