| Summary: | (1) Background: Neurological complications such as acute ischemic stroke or postoperative delirium are frequent after cardiac surgery or percutaneous valve replacement. This study aimed to identify corresponding risk factors. (2) Methods: 297 patients with percutaneous valve replacement or cardiac surgery were postoperatively screened for neurological complications such as delirium, stroke, seizures and hallucinations twice daily for three days. Pre- and perioperative risk factors were evaluated in a multivariate model. (3) Results: Neurological complications occurred in 43.8% (<i>n</i> = 130) as composed of delirium (43.43%, <i>n</i> = 129), stroke (2.7%, <i>n</i> = 8), seizures (1.35%, <i>n</i> = 4) and real hallucinations (3.36%, <i>n</i> = 10). Multiple logistic regression revealed an association of neurological complications with lower Montreal Cognitive Assessment scores (Exp(B) 2.042; 95% CI, 1.183–3.525, <i>p</i> = 0.010), older age (Exp(B) 1.071; 95% CI, 1.036–1.107, <i>p</i> < 0.001), red blood cell transfusions until postoperative day 3 (Exp(B) 1.157; 95% CI, 1.030–1.300, <i>p</i> = 0.014), history of heart failure (Exp(B) 1.985; 95% CI, 1.130–3.487, <i>p</i> = 0.017) and increased CRP levels (Exp(B) 1.004; 95% CI, 1.000–1.008, <i>p</i> = 0.037). (4) Conclusions: Postoperative delirium remains a frequent complication after cardiac surgery, while stroke and seizures occur rarely. A preoperative risk profile including older age, history of heart failure and cognitive impairment was identified for a complicated postoperative course. However, the impact of an intense inflammatory response must not be neglected.
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