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.