**5. Conclusion**

We did not find in the literature significant differences in terms of clinical results regarding post-operative mortality. One of the reasons is because the MECC strategy is widely applied in low risk populations and only few Authors describe the use of MECC in high-risk patients (Puehler 2011, Koivisto 2010). At the moment, most of the clinical benefits with the use of MECC were seen in the SIRS, hemodilution, platelet function protection.

The good amount of data described in favor of MECC could induce to apply this strategy in more cardiac surgical operations. However, the MECC system presents some limitations that create some concern about a wider use of this technique. One important limitation is high risk of air entrapment along the venous line that could suddenly stop the cardiopulmonary bypass. Another limitation is the need of learning curve because, as well as in the OPCAB, the MECC technique requires an experienced team (surgeon, anesthesiologist and perfusion) before to be applied routinely in all CABG patients and by all surgical staff.

We feel that the MECC technology gives better advantages than standard ECC and we feel that MECC could be applied to other surgical procedures. Of course more randomized, large, multicenter studies are mandatory to verify the safety of this technology in such cardiac complex surgical operation (aortic dissection, congenital disease).
