The introduction of minimally invasive extracorporeal circulation (ECC) systems in the early 2000s, along with the publication of the Minimally Invasive Extra-Corporeal Technologies international Society (MiECTiS) position paper in 2016, marked a significant step towards improving the biocompatibility of cardiopulmonary bypass, reducing its adverse effects, and enhancing end-organ protection. The specification of these systems aimed to clarify their use and facilitate international harmonisation. However, despite these efforts, MiECC technology has struggled to achieve widespread acceptance, with safety concerns and limited applicability cited as key reasons. Even the advancement of a Type IV system, which allows MiECC systems to be rapidly converted to an open CPB circuit in cases of major bleeding or extended surgery, has not gained substantial traction.

Nevertheless, the development of minimally invasive CPB systems has substantially influenced today’s optimised CPB systems. Features such as suction blood separation, coated tubing, reduced foreign surfaces, the use of centrifugal pumps, and, where feasible, minimisation of blood-air contact are now standard in these systems. In addition to optimising CPB systems from a technical standpoint, consideration of perfusion physiology is also essential.

As CPB technologies have evolved, so too has the approach to patient perfusion, moving from rigid specifications to a more patient-adapted perfusion strategy. Modern perfusion systems enable the continuous measurement of parameters such as DO₂i, NIRS, SvO₂, and others, and correlate these with patient vital signs. The data-gathering capabilities of these advanced systems represent a major step towards evidence-based perfusion.

An optimised perfusion strategy thus combines technological advancements with clinical research, forming the foundation of a modern approach to perfusion.

‍