Minimal invasive extracorporeal circulation (MiECC): the state-of-the-art in perfusion

Significant advances in cardiac surgery including surgical techniques, anaesthesia and intensive care management markedly improved clinical outcomes. However, cardiac surgery is still hampered by considerable morbidity and subsequent mortality, especially in complex and high-risk procedures. Evolution of Minimal invasive Extracorporeal Circulation (MiECC) represents a major break-through in perfusion. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. Consequently, MiECC use is translated into improved end-organ protection, which depicts in its clinical benefits observed in multiple clinical trials and meta-analyses. Furthermore, MiECC provides the base for developing a multidisciplinary intraoperative strategy which encompasses surgeon’s particular technique, goal-directed perfusion from perfusionist’s perspective as well as point-of-care heparin/protamine and coagulation management from the anaesthesiologist’s perspective. This strategy may turn a surgical procedure into therapy. In overall, taking under account the available data from the literature, the need for reduced morbidity in cardiac surgery and the contemporary quest for “more physiologic” intraoperative perfusion, we consider that MiECC represents the state-of-the-art in perfusion; therefore, we advocate that MiECC should become the standard practice in performing cardiac surgery.