Academic medicine has reached a cross-road around the world. The explosion of technology, new medicines and techniques, instant international communications and globalization, coupled with countries needs to reduce spiraling health care costs has lead to a questioning of the need for academic centers as they have existed in the past. Death from cardiovascular diseases continues to be among the leading causes of death around the world and so academic cardiac surgery will have to accept and master the challenges that it now faces if it is to survive and thrive in the future. Cardiac surgery in Croatia has a unique opportunity now to model itself after successful programs in Europe and the United States, which have not only survived in this new milieu, but serve as new models for academic cardiac surgery.