The rapid diffusion and uptake of new technology into the clinical practice of surgery and anesthesia has had an immense impact in recent years, particularly in cardiac surgery and anesthesia. Anesthesiologists have been instrumental in producing evidence-based medicine that is valid and clinically relevant. The increased availability, credibility, applicability, and generalizability of clinical research have resulted in an improvement in the monitoring, diagnostic and management in cardiac anesthesiology. We must understand the novelty and direction of technology and cardiovascular science leading the cardiac surgery, in order to position cardiac anesthesiology in advancing the innovative care of these patients. In this issue of Anesthesiology Clinics, Guest Editor Dr. Davy Cheng has brought together a distinguished panel of clinician-scientists and experts in the field to summarize the current state of the evidence and the future direction in the topics of genomics, perioperative echocardiography, minimally invasive and robotic cardiac surgery, transcathether valvular surgery, endovascular stenting of thoracic aortic aneurysm, transmyocardial laser revascularization, perioperative organs (brain, heart, liver and kidney) protection and management, as well as postoperative analgesia in cardiac surgery.