Despite advances in perioperative management, thoracic surgery remains a high-risk procedure for many patients. A systematic review of cardiac complications after thoracic surgery is presented. Most reviews about noncardiac thoracic surgery discuss postoperative analgesic regimens and pulmonary complications. In the present review, we also discuss atrial fibrillation as the most frequently encountered cardiac side effect. An evidence-based approach to other complications, such as myocardial ischemia, pulmonary edema, embolism, and shunt, is described. Furthermore, we offer recommendations for daily practice.