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This study was a retrospective examination of the influence of multimodality neuromonitoring on the incidence of serious brain injury associated with a common type of adult cardiac surgery, coronary artery bypass grafting (CABG). Multichannel EEG, cerebral oximetry, and transcranial Doppler ultrasound were used to detect and correct imbalances in cerebral perfusion and oxygenation. Imbalances were detected in 59% of the cases and successfully corrected in all but 2%. In the absence of neuromonitoring, the expected incidence of serious brain injury is 6.1%. With neuromonitoring, the actual observed incidence was 3.0% (P = 0.03). The apparent improvement can be attributed primarily to a reduction in the number of nonembolic diffuse injuries.