On-pump beating heart surgery has been proposed as a superior technique for cardiac surgery, and is receiving renewed interest from cardiac surgeons. Here, we review the technique, focusing on the basic principles of myocardial protection, operative methodology, category, intraoperative concerns, current status, organ protection, advantages, disadvantages, indications, contraindications, unanswered questions, and future research. (Heart, Lung and Circulation 2011;20:295-304) (C) 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.