From less invasive to minimal invasive extracorporeal circulation

Area of Science:

• Cardiovascular Surgery
• Perfusion Technology
• Medical Device Innovation

Background:

• Minimally invasive cardiac surgery (MICS) aims to reduce surgical trauma compared to full sternotomy.
• Extracorporeal circulation (ECC) is fundamental to MICS but often requires invasive cardiopulmonary bypass (CPB) techniques.
• Current CPB methods facilitate MICS maneuvers but can increase procedure duration and physiological derangement.

Purpose of the Study:

• To introduce Minimal invasive Extracorporeal Circulation (MiECC) as a significant advancement in cardiac surgery perfusion.
• To highlight MiECC's role in optimizing intraoperative perfusion and cardiovascular physiology.
• To demonstrate how MiECC can enhance MICS outcomes and contribute to a more physiologic surgical approach.

Main Methods:

• Integration of contemporary technological advancements in perfusion.
• Application of optimized perfusion techniques and assisted venous drainage.
• Utilizing centrifugal pumps to facilitate surgical maneuvers during MICS.

Main Results:

• MiECC represents a major breakthrough in perfusion technology.
• Clinical trials and meta-analyses show improved end-organ protection and patient outcomes with MiECC.
• MICS combined with MiECC facilitates a multidisciplinary strategy for "more physiologic" cardiac surgery.

Conclusions:

• MiECC integration advances MICS beyond non-full sternotomy towards truly "more physiologic" cardiac surgery.
• This approach combines minimal surgical trauma with reduced physiological derangement.
• MiECC is pivotal for modern cardiac surgery, especially in the transcatheter era.