Rafael Sádaba, Ernst Wolner and José Luis Pomar look back at how dramatically cardiac surgery has changed over the past 40 years. They recall a time of basic operating rooms, limited imaging, difficult access to new techniques and major debates over approaches such as hot versus cold cardioplegia. They discuss the evolution of coronary and valve surgery, minimally invasive and robotic techniques... The conversation also considers what has been lost as surgery has become more specialised, and what still needs to improve, although patient care remains at the heart of the specialty.