The still unchanged high morbidity and mortality of patients undergoing complex cardiac surgical procedures as well as developments in minimally invasive cardiac surgery are not only an ongoing challenge for all working in cardiac anaesthesia but also a chance for further developing this anaesthetic subdiscipline. Alongside the presentation of a case report, the present article gives an overview about recent developments in inotropic therapy, monitoring, the rational use of mechanical circulatory support, volume therapy, sedation, analgesia, and point-of-care coagulation monitoring in cardiac anaesthesia.