In reviewing this month's Table of Contents for the journal, I see technologies that would not have been dreamed of when I was contemplating cardiology as a career. There are articles on improved transcatheter aortic valve implantation (TAVI) valves, radiofrequency and ozone-mediated renal artery denervation for hypertension, mitral transcatheter edge-to-edge repair for cardiogenic shock, diagnostic methods for microvascular disease, lithotripsy for calcified aortic valves, use of antithrombotics for polymeric stent implantation, and the use of extracorporeal membrane oxygenation combined with left ventricular assist devices. These technological advances, and many more, including artificial intelligence, are showcased in our medical literature constantly. The terms have become familiar even though we have limited knowledge about how they work or were developed. For drug therapies, immunotherapies and genomic interventions, we are even less sure about their mechanism of action, but we do want to know if they work. Just as our cars have become computers on wheels that we have no clue how to fix, our medical advances have evolved to become much more complex.