Objective To explore the differences in clinical application effects between minimally invasive extracorporeal circulation (MiECC) technology and conventional extracorporeal circulation (CECC) technology in cardiac surgery for elderly patients. Methods A total of 94 elderly patients aged 70 years and above who underwent cardiac valve and/or coronary artery bypass grafting surgery (CABG) at the Shanghai Geriatric Medical Center were selected and randomly divided into the MiECC group and the CECC group for a prospective study. Basic information, perioperative indicators, and clinical outcomes of the two groups were collected, and the differences in clinical application effects between MiECC technology and CECC technology were compared and analyzed. Results There were no postoperative deaths in either group. No significant statistical differences were observed between the two groups in terms of extracorporeal circulation time, ascending aortic occlusion time, mechanical ventilation time, intensive care unit (ICU) stay duration, and the incidence of postoperative related complications (arrhythmia, drainage volume, stroke, acute kidney injury (AKI) ) (all P > 0.05). The intraoperative hemoglobin (Hb) concentration was significantly higher in the MiECC group (P < 0.01), and the percentage decrease in intraoperative Hb concentration was also significantly lower (P < 0.05). The Hb concentration at 24 hours postoperatively was significantly higher in the MiECC group than in the CECC group (P < 0.05). Postoperative pulmonary exudation was also significantly lower in the MiECC group than in the CECC group (P < 0.05). Conclusion MiECC technology demonstrates superior clinical effects compared to CECC technology in cardiac surgery for elderly patients, showing certain advantages in maintaining intraoperative Hb concentration and reducing postoperative pulmonary exudation, with good safety and practicality.