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A Trends Analysis and Scoping Review: Minimal Invasive Extracorporeal Circulation
Doğuş Hemşinli1, Sedat Ozan Karakişi1, Hülya Kılıç2
1Faculty of Medicine, Department of Cardiovascular Surgery, Recep Tayyip Erdoğan University, Rize, Türkiye.
Purpose:
The minimal invasive extracorporeal circulation (MiECC) was developed as abiocompatible alternative to conventional cardiopulmonary bypass (cCPB), intending to mitigate haemodilution, lessen the systemic inflammatory response, and enhance organ protection. AQ2 Although the evidence base has grown over the past 30 years, there has been no systematic mappingof the evolution of research activity and its results.
Methods:
The objectives are to perform a detailed analysis of the temporal, geographical, methodological, and clinical trends within MiECC research published between 1990 and 2025. Studies involving original human clinical data (randomized controlled trials, cohort studies, observational reports, methodological or protocol papers) that reported perioperative or clinical outcomes of MiECC were included. Exclusion criteria comprised reviews, meta-analyses, editorials, letters, guidelines, animal studies, and conference abstracts lacking full text. A comprehensive search of PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases was conducted up to September 2025 to gather evidence. Reference lists of included articles and relevant reviews were also screened. Data were extracted on publication year, country, sample size, study design, surgical procedure, and reported outcomes. Two reviewers independently charted the data, and discrepancies were resolved by a third reviewer.
Results:
A total of 151 studies were identified, of which 128 met eligibility criteria. Publication activity increased substantially after 2002 and peaked in 2021, with major contributions from European centres (Germany, Italy, Switzerland, Greece, and the Netherlands). Methodological/protocol papers and Randomize Controlled Trials (RCT) predominated (respectively, n = 37, n = 36). Most studies focused on coronary artery bypass grafting (CABG), while valve surgery and paediatric populations were underrepresented. Reported outcomes shifted over time: early studies emphasised transfusion and inflammatory markers, whereas more recent investigations increasingly examined renal function, neurological complications, and survival. Subgroup analyses suggested notable benefits in elderly patients, those with renal dysfunction, and individuals with low ejection fraction (EF).
Conclusion:
MiECC research has progressed from feasibility series to large multicentre trials, generating evidence for reduced transfusion requirements, attenuated inflammatory response, and better organ protection, though no clear mortality benefit has been demonstrated.
Insights
Minimal invasive extracorporeal circulation (MiECC) research shows improved organ protection and reduced transfusions compared to conventional cardiopulmonary bypass (cCPB). While not demonstrating mortality benefits, MiECC research has evolved significantly, focusing on patient outcomes and organ function.
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Research Trends Analysis
Background:
- Minimal invasive extracorporeal circulation (MiECC) was developed as a biocompatible alternative to conventional cardiopulmonary bypass (cCPB).
- The aim of MiECC is to mitigate hemodilution, reduce systemic inflammatory response, and enhance organ protection.
- Despite growing evidence over 30 years, a systematic mapping of MiECC research evolution and outcomes is lacking.
Purpose of the Study:
- To analyze temporal, geographical, methodological, and clinical trends in MiECC research from 1990 to 2025.
- To systematically map the evolution of research activity and its results in the field of MiECC.
- To identify shifts in research focus and reported outcomes over time.
Main Methods:
- A comprehensive search of major databases (PubMed/MEDLINE, Web of Science, Scopus, Cochrane) up to September 2025.
- Inclusion of studies with original human clinical data (RCTs, cohort studies, observational reports, protocol papers) reporting perioperative or clinical outcomes.
- Exclusion of reviews, meta-analyses, editorials, animal studies, and conference abstracts lacking full text; data extraction by two independent reviewers.
Main Results:
- 128 studies met eligibility criteria, with publication activity increasing substantially after 2002 and peaking in 2021.
- European centers, particularly Germany and Italy, were major contributors; methodological/protocol papers and RCTs predominated.
- Research focus shifted from transfusion/inflammatory markers to renal function, neurological complications, and survival, with benefits noted in elderly, renal dysfunction, and low EF patients.
Conclusions:
- MiECC research has advanced from feasibility studies to large multicenter trials.
- Evidence supports reduced transfusion needs, attenuated inflammatory response, and improved organ protection with MiECC.
- No clear mortality benefit has been demonstrated, but research shows progress in patient outcomes.
