From the dawn of open-heart surgery in the early 1950s, a sequence of significant scientific achievements rendered cardiac surgery as a routine practice in the treatment of heart diseases. Contemporary advances in cardiac surgery including surgical techniques, anaesthesia and intensive care management markedly improved clinical outcomes. However, cardiac surgery is still hampered by considerable morbidity and subsequent mortality, especially in complex and high-risk procedures. As evidenced in the largest cardiac surgery registry (STS database) that incorporates data from over 200,000 procedures, operative results are excellent irrespective of surgical technique in the setting of low-risk elective coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) or mitral valve repair (1). However, significant operative mortality and major morbidity (approaching the rate of 30%) is still observed not only in high-risk cases such as emergency CABG or acute aortic dissection repair, but also in the most common scenario of an isolated mitral valve replacement (MVR) or an elective combined procedure like AVR+CABG and MVR+CABG (Table 1). This literally means that in real-world one out of three patients may experience a serious postoperative complication in this setting.