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Since the start of cardiac surgery with cardiopulmonary bypass in the 1950s, considerable research has been performed to reduce the detrimental effects of cardiac surgery. Developments such as minimally invasive cardiac surgery and off-pump coronary bypass, but also optimization of cardioplegic, priming and anesthetic strategies have contributed to the overall reduction in patient morbidity and mortality. Despite these advances, the microcirculation remains a black box during cardiac surgery. It is however clear that microvascular dysfunction is considered a significant contributor to organ failure.