This chapter ushers in first beginnings of inventive but rudimentary surgery directly on the heart leading eventually to the development of open heart surgery. The first heart abnormal succumbing to this approach were sticky and leaky valves—stenotic mitral and pulmonary valves. With the advent of cardiopulmonary bypass, more complex defects are tackled. We meet Charles Bailey, W.G. Bigelow, F. John Lewis, C. Walton Lillehei, Owen Wangensteen, Henry Swan among others. Personalities, innovative techniques and devices are discussed. Finally ethical issues regarding surgical innovation are touched on.