Minimal Invasive Extracorporeal Circulation Versus Conventional Cardiopulmonary Bypass in Cardiac Surgery: A Contemporary Systematic Review and Meta-Analysis

The question of whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion strategy in cardiac surgery remains unanswered. The authors aimed to systematically review the entire literature and thoroughly address the impact of MiECC vs conventional cardiopulmonary bypass (cCPB) on adverse clinical outcomes after cardiac surgery. Major databases, including PubMed, Scopus, and Cochrane, were searched for relevant articles as well as conference proceedings from major congresses up to August 31, 2024. All randomized controlled trials (RCTs) that fulfilled universally accepted MiECC criteria were included in the analysis. The primary outcome was mortality, while morbidity and transfusion requirements were secondary outcomes. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. All studies that met the outcomes of interest of this systematic review were eligible for synthesis. Of the 738 records identified, 36 RCTs were included in the meta-analysis, with a total of 4,849 patients. MiECC was associated with significantly reduced mortality (OR 0.66; 95 percent CI: 0.53-0.81; p=0.0002; I2=0 percent) as well as risk of postoperative myocardial infarction (OR 0.42; 95 percent CI: 0.26-0.68; p=0.002; I2=0 percent) and cerebrovascular events (OR 0.55; 95 percent CI: 0.37-0.80; p=0.007; I2=0 percent). Additionally, MiECC reduced RBC transfusion requirements, blood loss, and the rate of reexploration for bleeding, along with the incidence of atrial fibrillation. This resulted in significantly reduced durations of mechanical ventilation, ICU, and hospital stay. 
This is the largest meta-analysis published to date, providing robust evidence for the beneficial effect of MiECC in reducing postoperative morbidity and mortality after cardiac surgery and prompts for a wider adoption of this technology.