Recent developments in cardiac surgery and interventional cardiology have led to the installation of integrated operating rooms that allow both surgical and endovascular procedures. These units offer surgical as well as angiographic equipment and personnel and therefore require special planning and design. A variety of integrated procedures can be performed. Hybrid coronary revascularization, percutaneous valve repair, and aortic stent-graft placement are current developments that are ideally performed in a cath-lab operating room. This review by an international working group of cardiac surgeons and cardiologists outlines the challenges involved with implementation of an integrated operating suite and suggests general planning and construction guidelines.