Extracorporeal circulation and the most frequent intraoperative and postoperative complications in cardiac surgeries.

Abstract

Extracorporeal circulation (ECC) is an indispensable technology in contemporary cardiac surgery, but it is associated with a broad spectrum of intraoperative and postoperative complications that can negatively impact morbidity, mortality, and patient recovery time. This study aimed to narratively review the main complications related to the use of ECC, with emphasis on inflammatory, hematological, pulmonary, and neurocognitive alterations, as well as to discuss current prevention and management strategies. This is a literature review conducted in databases such as PubMed, SciELO, Web of Science, and Google Scholar, including classic studies and recent publications on systemic inflammatory response, coagulopathy, acute lung injury, and postoperative cognitive dysfunction in cardiac surgery with ECC. The findings show that blood contact with the extracorporeal circuit—combined with surgical trauma and ischemia-reperfusion—triggers a systemic inflammatory response and hemostatic alterations, contributing to multiple organ dysfunction, increased need for intensive support, and longer hospital stays. Pulmonary complications and neurocognitive disorders are particularly prevalent in elderly patients and those with comorbidities, reinforcing the importance of risk stratification and individualized care protocols. Technologies such as minimally invasive extracorporeal circulation, biocompatible circuits, and multimodal hemostatic, pulmonary, and cerebral protection strategies have shown potential to reduce adverse events, although gaps remain in the standardization and widespread implementation of these approaches. It is concluded that early recognition of complications, together with the adoption of evidence-based practices, is essential to making the use of ECC safer, improving the quality of care in cardiac surgery, and guiding future research in the biomedical field.