Over the years, efforts have been made to reduce complications and improve the outcomes of cardiac surgery. There is also a push to reduce costs and decrease length of stay associated with cardiac surgery. In the mid-1990s, advances were made that allow surgeons to perform coronary artery bypass on a beating heart (off-pump coronary artery bypass). Further advances in technology and surgical techniques allow surgeons to perform coronary artery bypass and valve surgeries without the use of a midline sternotomy, using endoscopic techniques, and with the assistance of robotic technologies. This chapter helps nurses to learn how cardiac surgeries are performed without cardiopulmonary bypass. It describes several technologies and robotic devices that surgeons use to perform minimally invasive surgeries such as minimally invasive direct coronary artery bypass surgery and minimally invasive valve surgery. The chapter then discusses the complications that may occur as a result of a minimally invasive surgery.