In high-risk high-stakes environments, such as the cardiac operating room (OR), the cognitive processes of each surgical team member, as well as alignments or misalignments between team members play a critical role in team performance and consequent patient care quality and safety. In OR settings, a multidisciplinary team approach is essential, with each member, individually and as a team, playing a pivotal role in surgical outcomes. This study’s goal was to investigate the cognitive processes of cardiac surgery teams, particularly focusing on the potential misalignment between surgeons, anesthesiologists, and perfusionists during coronary artery bypass grafting (CABG) procedures. We evaluated critical intraoperative cognitive processes, including decision-making, communications, and problem-solving strategies across different phases of CABG procedures, providing quantitative measurements of misalignments within the teams, and reporting the specific phases of surgery that have the highest cognitive process misalignments. By analyzing these cognitive dynamics, our goal is to enhance the understanding of team coordination and cognitive distribution in the operating room. Specifically, by pinpointing where and how cognitive misalignments occur, we can develop targeted interventions. These interventions aim to streamline communication, decision-making, and problem-solving, ultimately contributing to improved patient care and team efficiency in cardiac surgery.