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Meta-Analysis
. 2025 Mar 28;67(4):ezaf112.
doi: 10.1093/ejcts/ezaf112.

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

Kyriakos Anastasiadis  1 , Polychronis Antonitsis  1 , Christos Voucharas  1 , Fani Apostolidou-Kiouti  2 , Apostolos Deliopoulos  1 , Anna-Bettina Haidich  2 , Helena Argiriadou  3
Affiliations
Meta-Analysis

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

Kyriakos Anastasiadis et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The question whether minimally invasive extracorporeal circulation (MiECC) represents the optimal perfusion strategy in cardiac surgery remains unanswered. We sought to systematically review the entire literature and thoroughly address the impact of MiECC versus conventional cardiopulmonary bypass (cCPB) on adverse clinical outcomes after cardiac surgery.

Methods: We searched PubMed, Scopus and Cochrane databases for appropriate articles as well as conference proceedings from major congresses up to 31 August 2024. All randomized controlled trials (RCTs) that fulfilled pre-defined 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 meeting the outcomes of interest of this systematic review were eligible for synthesis.

Results: Of the 738 records identified, 36 RCTs were included in the meta-analysis with a total of 4849 patients. MiECC was associated with significantly reduced mortality [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.53-0.81; P = 0.0002; I2 = 0%] as well as risk of postoperative myocardial infarction (OR 0.42; 95% CI 0.26-0.68; P = 0.002; I2 = 0%) and cerebrovascular events (OR 0.55; 95% CI 0.37-0.80; P = 0.007; I2 = 0%). Moreover, MiECC reduced RBC transfusion requirements, blood loss and rate of re-exploration for bleeding together with incidence of atrial fibrillation. This resulted in significantly reduced duration of mechanical ventilation, ICU and hospital stay.

Conclusions: This meta-analysis provides 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.

Keywords: Cardiopulmonary bypass; Coronary artery bypass grafting; Extracorporeal circulation; Meta-analysis; Minimal invasive extracorporeal circulation.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
Forest plot of randomized trials comparing mortality in patients operated with minimally invasive extracorporeal circulation (MiECC) versus conventional cardiopulmonary bypass (cCPB). A significant reduction in mortality (P = 0.002) was observed with the use of MiECC.
Figure 2:
Figure 2:
Forest plot of randomized trials comparing the incidence of postoperative myocardial infarction in patients operated with minimally invasive extracorporeal circulation (MiECC) versus conventional cardiopulmonary bypass (cCPB). A significant reduction in the rate of postoperative myocardial infarction (P = 0.002) was observed with the use of MiECC.
Figure 3:
Figure 3:
Forest plot of randomized trials comparing the incidence of postoperative cerebrovascular events in patients operated with minimally invasive extracorporeal circulation (MiECC) versus conventional cardiopulmonary bypass (cCPB). A significant reduction was observed with the use of MiECC (P = 0.007).
Figure 4:
Figure 4:
Forest plot of randomized trials comparing the incidence of red blood cells (RBC) transfusion in patients operated with minimally invasive extracorporeal circulation (MiECC) versus conventional cardiopulmonary bypass (cCPB). A significant reduction in the rate of blood transfusion (P = 0.006) was observed with the use of MiECC.
See this image and copyright information in PMC

References

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