Cost-effectiveness analysis (CEA) in cardiac surgery continues to grow in relevance with increasing health care expenditures, a greater emphasis on value-based care, the continuing development of costly surgical and noninvasive technologies, advances in cardiac devices, and changes in eligibility criteria over the past two decades. Although the rapidly evolving surgical technologies pose challenges to CEA, improvements in gathering and leveraging long-term economic and clinical data alongside trials and in cardiac surgery registries represent future opportunities for the field. As such, it is important for cardiac surgeons to understand CEA with respect to existing and future surgical therapies. Herein, we review the fundamental principles of cost-effectiveness analysis theory and discuss recent cost-effectiveness studies on cardiac surgery.