Cardiac surgery has undergone remarkable changes in the last 2 decades. Percutaneous coronary interventions (PCI) were becoming increasingly sophisticated, and patients preferred these to the more durable but invasive option of surgery. Spurred by this, the evolution towards less invasive techniques in cardiac surgery was led by coronary bypass surgery, which of course involved operating on the surface of the heart. The development of less invasive techniques for valve surgery began in the mid-1990s, with advances made simultaneously in the United States and Europe. It became possible to operate inside the heart using techniques that spared the sternum partially or completely. The ability to access all the chambers of the heart with these techniques made it possible to deal with cardiac tumors as well. Less invasive advances in other surgical specialties preceded cardiac surgery and provided some of the ideas that were applied to the special problems of operating in the thorax and, in particular, on the heart. It was clear that there were 2 main groups of patients who would benefit from less invasive techniques in cardiac surgery: 1) patients who want it, including those who are the breadwinners or the main care providers in a family, and 2) patients who need it, mainly elderly, steroid dependent, debilitated, or deconditioned patients. This article offers an overview of the development of less invasive techniques in cardiac surgery and how they have been adapted for cardiac tumors.