Minimally invasive direct coronary artery bypass and transmyocardial laser revascularization are examples of 'beating heart' surgery which embrace new medical concepts, and the philosophy that less invasive cardiac procedures (eg, smaller incisions, avoidance of cardiopulmonary bypass) can safely achieve surgical goals. Patient and care provider expectations must be aligned with these issues if potential benefits are to be translated into improved patient outcome with accelerated recovery, and reduced cost for health care systems and society. There is a major role for anesthesiologists in this process, including patient and care provider education, anesthetic design to appropriately involve fasttracking principles and analgesia strategies, and the development of safe postoperative care plans outlining criteria for accelerated recovery and reduced intensive monitoring. Although enthusiasm is currently fuelling the widespread introduction of 'beating heart' surgery, evidence for comparison of these procedures to traditional techniques is currently insufficient to confirm that they will become the established practice.