Cardiovascular surgery has substantially improved survival and quality of life for patients with cardiovascular disease, yet contemporary surgical populations are increasingly older, multimorbid, and affected by advanced disease, rendering procedures and perioperative care more complex. Patients often experience severe physical symptoms, psychological distress, and difficult decisions, which in cases of complications also include escalation, limitation, or withdrawal of life-sustaining treatment. In this article, we argue that palliative care offers a framework to address these complex needs throughout the entire cardiovascular surgery pathway, rather than only at the end of life. Preoperatively, structured shared decision-making, goals-of-care discussions, and advance care planning can help align surgical strategies with patients’ values and prepare patients and families for potential complications. Postoperatively, routine assessment and management of physical symptoms, psychological distress, social needs, and spiritual concerns could prevent and alleviate suffering during the hospitalization. In the setting of serious complications, interdisciplinary team support, regular family meetings, and professional communication can support decision-making and reduce distress for patients, families, and clinicians. Most palliative care needs can be addressed by surgical and intensive care teams as primary palliative care, while specialty palliative care should be involved for complex symptoms, decisional conflict, or challenging psychosocial or existential distress. Further research, education, and guideline development are needed to change professional culture and establish palliative care as a routine, complementary component of cardiovascular surgical care.