We aimed to compare postoperative clinical outcomes between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) in patients undergoing cardiac surgery.

We performed a meta-analysis of randomized controlled trials comparing MiECC and CECC in adult cardiac surgery. A literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane library databases from inception to July 2026 to identify relevant studies. Primary outcomes included mortality, myocardial infarction, atrial fibrillation, stroke, acute kidney injury, delirium, transfusion requirements, ICU length of stay, ventilation duration, and hospital length of stay.

Forty-one RCTs with a total of 5215 patients (2652 in MiECC group, and 2563 in CECC group) were included. MiECC was associated with decreased myocardial infarction (RR = 0.50, 95% CI [0.34, 0.73], p-value = 0.0004), atrial fibrillation (RR = 0.82, 95% CI [0.72, 0.93], p-value = 0.002), stroke (RR = 0.50, 95% CI [0.27, 0.93], p-value = 0.03), delirium (RR = 0.42, 95% CI [0.24, 0.73], p-value = 0.002), chest tube drainage (RR = −123.27, 95% CI [−165.41, −81.13], p-value <0.00001), units of transfused RBC (MD = −0.67, 95% CI [−0.84, 0.49], p-value <0.00001), ICU length of stay (MD = −0.99, 95% CI [−1.42, 0.56], p-value <0.00001), hospital length of stay (MD = −0.61, 95% CI [−1.09, −0.12], p-value = 0.01) and ventilation duration (MD = −2.71, 95% CI [−3.72, −1.69], p-value <0.00001) compared to CECC. However, no significant differences were observed between both groups in terms of mortality, transient ischemic attack, acute kidney injury, reoperation for bleeding, and platelet transfusions.

MiECC may provide myocardial and neurological protection, better hemostasis, and faster early postoperative recovery compared to CECC, supporting its adoption as a preferred perfusion strategy in cardiac surgery.