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Abstract
The main challenge of modern cardiac perfusion technologies is the achievement of optimal biocompatibility for extracorporeal circulation (ECC) circuits. The unfavorable pathophysiological side effects of conventional cardiopulmonary bypass (CPB) circuits on the organ systems are triggered by complement system activation through foreign surfaces, hemodilution due to the priming volume, blood-air contact as well as negative and positive pressures in the reservoir (1,2). To overcome these effects, the concept of minimal invasive extracorporeal circulation (MiECC) circuits has evolved over the last 20 years as an alternative to the more conventional ECC circuits but also as an alternative to off-pump strategy for coronary artery bypass grafting (CABG) (3,4). The use of MiECC circuits is now expanding. These systems offer several potential advantages because they reduce the systemic inflammatory response and subsequent organ dysfunction (5,6). In order to be strongly characterized as MiECC, the main components of the system must include a closed CPB circuit; biologically inert blood contact surfaces; reduced priming volume; a cardioplegia system; a venous bubble trap/venous air removing device and a shed blood management system (6). MiECC circuits are classified in four different types with modular components, which are described in the following sections.