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Permanent neurological deficit (PND) is a relatively rare but serious complication of cardiac surgery, associated with a high mortality and a poor prognosis for an acceptable quality of life. A few predictive models of PND have been developed; however, it is not certain whether they may be extrapolated to any cardiac surgical population. We aimed to assess the epidemiology and identify predictors of PND on the basis of a single, prospective hospital database from Eastern Europe.We performed a retrospective review of 6016 consecutive adult patients (coronary revascularisation with or without cardiopulmonary bypass - 3,613 patients; isolated single-, double- or triple-valve repair or replacement - 1,221 patients; CABG+valve repair or replacement - 563 patients; aortic aneurysm surgery - 228 patients; and other procedures - 391 patients). PND was defined as a new focal or global disorder of cerebral function lasting longer than 24h and still present at the time of hospital discharge or the patient's death. Thirty independent preoperative, intra-operative and postoperative variables that might influence PND were selected and analysed.In total, PND was identified in 2.5% of patients (coronary surgery - 1.7%, isolated valve surgery - 2.9%, combined procedures - 5.3%, aortic aneurysm surgery - 7.5% and others - 2.2%). The overall mortality among patients with PND was very high in comparison to the remaining patients (40.4% vs 2.2%, p0.001). In a multivariate analysis, PND was associated with five variables: cardiopulmonary bypass time2h (odds ratio (OR) 3.35), emergency surgery (OR 3.34), early rethoracotomy (OR 3.17), age65 years (OR 1.70) and unstable course of cardiac disease (OR 1.60).PND after cardiac operation is associated with a high mortality and poor prognosis. The incidence of PND varies depending on the procedure. Predictive models of neurological injury post-cardiac surgery should be more centre-specific.