Conventional cardiopulmonary bypass (cCPB) remains fundamental to modern cardiac surgery, yet its associated hemodilution, blood–air interaction, inflammatory activation, coagulation disturbance, and microembolic burden continue to affect perioperative organ protection and postoperative recovery. Minimal invasive extracorporeal circulation (MiECC), characterized by a closed circuit, reduced priming volume, centrifugal pump support, biocompatible surface coating, and modular integration, was developed to minimize the physiological disturbance associated with extracorporeal circulation. This review provides an evidence-oriented overview of the definition, classification, pathophysiological rationale, major clinical applications, safety boundaries, and future directions of MiECC. Current evidence is most mature in coronary artery bypass grafting (CABG), where MiECC has been associated with reduced hemodilution, lower transfusion requirements, improved fluid balance, attenuation of the systemic inflammatory response, and facilitation of postoperative recovery. Expanding evidence in valve surgery, aortic surgery, and pediatric cardiac surgery suggests potential value in selected settings, although outcomes remain more dependent on procedural complexity, system configuration, and team experience. For major safety endpoints such as mortality and stroke, MiECC appears overall at least comparable to conventional extracorporeal circulation, while recent meta-analytic evidence has suggested a possible mortality advantage in favor of MiECC. Importantly, MiECC should not be viewed merely as a smaller bypass circuit, but as a systems-based and increasingly patient-tailored perfusion strategy. Its future development may lie in evolving from a biologically optimized extracorporeal support platform toward a true precision perfusion model integrating patient stratification, tailored circuit configuration, and goal-directed management. Broader implementation, especially in mainland China, will depend on standardized protocols, multidisciplinary training, cost-effectiveness evidence, and center-level quality control.