Minimally invasive cardiopulmonary bypass in pediatrics

Minimally invasive cardiopulmonary bypass (MICPB) systems aim is to improve the biocompatibility of cardiopulmonary bypass components, minimize adverse effects, and improve organ protection. MICPB consists of a closed circuitry with a membrane oxygenator and a centrifugal pump, but without the venous reservoir with reduced priming volume, decreased surface area, and less blood–air interface. The advantages of using MICPB are lower systemic inflammatory response, reduced hemodilution, less activation of coagulation cascades, and lower requirement for blood transfusions. The use of MICPB brings clinical benefits, lower incidence of myocardial damage, atrial fibrillation, low cardiac output syndrome, neurological complications, and respiratory insufficiency with a reduced postoperative hospital stay. The clinical acceptance and application of MICPB in adult cardiac surgery are not widely spread. The risk of air embolism in closed MICPB systems limits the clinical application. The complex air-handling characteristics with increased risk of air embolism and the difficult volume handling in ventricular dilatation or excessive bleeding represent the most considerable objection regarding omitted venous reservoirs. Due to the very nature of congenital heart disease repair in newborns, infants, and children, a closed-circuit MICPB is hardly applicable with few exceptions. However, strategies to miniaturize the CPB circuitry and manage perfusion have been developed in pediatric cardiac surgery through the years, thereby representing a valid surrogate of a MICPB in children.