Haemostasis and minimally invasive extracorporeal circulation

Advances in extracorporeal circulation using a minimally invasive circuit have rapidly emerged, and the components and biocoatings of the minimally invasive extracorporeal circuit (MiECC) have improved. The application range of minimally invasive cardiopulmonary bypass has expanded, however the main indications for the use of MiECCs during cardiac surgery have not yet been systematized. To the best of our knowledge, no guidelines for anticoagulant therapy regimens during minimally invasive cardiopulmonary bypass exist, and its effect on blood loss and the activation of coagulation in the perioperative period remain unclear. The present review highlighted the components of the circuit and the practical aspects of using MiECC. We formulated indications for the use of minimally invasive circuits and classified biocompatible coatings used to reduce the contact activation of haemostasis. According to the literature, when performing cardiopulmonary bypass with MiECC, the physiological haemostatic balance is disturbed. The detected changes in plasma haemostasis do not allow drawing conclusions regarding the advantages of MiECC, despite its clinical benefits. Multicentre randomized trials that comply with the rules of the pre-analytical stage of haemostasis and use global tests (thrombin generation test, thrombodynamics test, etc.) are required. The available studies on the haemostatic system using MiECC are not adequate for determining whether MiECCs on a haemostatic system are recommendable. However, MiECCs allow physicians to get closer to the fast track cardiac surgery ideal. Received 7 October 2019. Revised 14 November 2019. Accepted 18 November 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.