The future of cardiac surgery? The hybrid operating room. The most advanced hospitals, both in Italy and abroad, are providing multimodal imaging systems (angiography and rotational angiography with three-dimensional reconstruction, three-dimensional echocardiography, fluoroscopy, CT scans) integrated into an environment equipped with the complete technology of a traditional cardiac surgery operating room. Inside the hybrid room, like that of the new Cardiac Surgery department of the Casa Sollievo della Sofferenza of San Giovanni Rotondo (Foggia) directed by Prof. Mauro Cassese, several specialists work simultaneously. This means less need to move patients around (especially in highly complex cases) and reduced costs of interventions and it allows multidisciplinary team to act in a safer, faster and more precise way. Coordinated by the primary surgeon and the staff of cardiac surgeons, a team of hemodynamists, cardiologists and cardio-ultrasonographers work together, guaranteeing an extremely effective decision-making process. In fact, having many professionals together helps guarantee the correct overview of the patient's clinical picture, identify the best procedures and better manage every possible emergency. It is indeed a complex organizational and technological solution. The mere presence of advanced instrumentation is not enough. The primary surgeon must set up a system in which each professional is able to move with dexterity and in maximum coordination with his colleagues. When this result is achieved, it is possible to undertake both traditional cardiac and vascular surgery, and interventional and endovascular cardiac procedures in the cardiac surgery room: transcatheter aortic valve implantation (TAVI), surgical and percutaneous myocardial revascularization, surgical aortic debranching, endovascular prosthesis implants and the treatment of any type of vasculopathy of surgical and endovascular interest. The hybrid room is particularly suitable for high risk patients, even if those who have previously been considered unsuitable for surgery. In short, undeniable advantages for the health and safety of patients, but also for the health service, thanks to the reduction of costs, both of interventions and of hospital stays.