Cardiac surgery has made extraordinary progress in the last few decades. This is largely the result of dedicated effort and almost perfect teamwork among cardiac surgeons and the allied specialty groups (anaesthesists are obviously part of it). The creativity, imagination and skills that have given rise to numerous technical innovations and surgical procedures have brought to reality the surgical treatment of the majority of the congenital malformations and the acquired lesions of the heart. The basic principles of patient selection and surgical technique in current adult cardiac surgical practice are outlined below.