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Patients and methods: Between October 2013 and November 2013, a total of 65 adult patients (46 males, 19 females; mean age: 66.1±8.6 years; range, 34 to 84 years) who underwent isolated CABG, aortic valve replacement (AVR), or combined AVR with CABG. The patients were stratified by preoperative risk, with higher-risk patients assigned to the MiECC group (n=30) and the remaining patients to the CECC group (n=35). Intra- and postoperative parameters, including cardiopulmonary bypass (CPB) time, aortic cross-clamp time, priming and cardioplegia volumes, 24-h drainage, transfusion requirements, mechanical ventilation duration, intensive care unit (ICU) and hospital stay, and mortality were evaluated.

Results: Patients in the MiECC group had higher baseline risk profiles, including older age, chronic obstructive pulmonary disease, and carotid artery stenosis. The MiECC was associated with significantly lower priming (506±54 vs. 1150±94 mL, p=0.001) and cardioplegia volumes (38±7 vs. 939±108 mL, p=0.001). Postoperatively, MiECC patients had shorter mechanical ventilation (6.4±2.0 vs. 10.2±4.9 h, p=0.001), ICU stay (24.5±4.2 vs. 45.7±6.3 h, p=0.001), and hospital stay (7.3±1.2 vs. 10.3±2.6 days, p=0.001). Blood product utilization, including red blood cells and fresh frozen plasma, was also significantly lower in the MiECC group. Mortality and major complications were comparable between the groups.

Conclusion: Despite higher baseline risk, MiECC provided favorable postoperative outcomes compared to CECC, including reduced transfusion needs, shorter mechanical ventilation, and shorter ICU and hospital stays. The MiECC appears to be a safe and effective strategy even in higher-risk cardiac surgical populations, potentially reducing perioperative morbidity.