Minimal invasive extracorporeal circulation versus conventional cardiopulmonary bypass in cardiac surgery: a contemporary systematic review and meta-analysis.

Summary

Across 36 randomized controlled trials (n=4849), MiECC was associated with lower mortality (OR 0.66, 95% CI 0.53–0.81; I2=0%), reduced postoperative myocardial infarction (OR 0.42, 0.26–0.68) and cerebrovascular events (OR 0.55, 0.37–0.80). MiECC also decreased RBC transfusion, blood loss, re-exploration for bleeding, atrial fibrillation, and shortened ventilation, ICU, and hospital stay.

Key Findings

• MiECC reduced mortality versus cCPB (OR 0.66, 95% CI 0.53–0.81; I2=0%).
• Lower risk of postoperative myocardial infarction (OR 0.42) and cerebrovascular events (OR 0.55) with MiECC.
• MiECC decreased RBC transfusions, blood loss, re-exploration for bleeding, atrial fibrillation, and reduced ventilation, ICU and hospital length of stay.

Clinical Implications

Cardiac anesthesia and perfusion teams should consider implementing MiECC circuits where expertise and resources permit, with protocols for anticoagulation, hemodilution, and circuit management standardized to MiECC criteria.

Limitations

• Variability in MiECC platforms and surgical techniques across trials
• Potential publication bias and limited reporting on long-term outcomes

Future Directions

Pragmatic multicenter implementation trials, standardized MiECC protocols, cost-effectiveness analyses, and registries to monitor real-world outcomes.