Currently, there is no unanimous agreement about the indications of surgical treatment for locally advanced lung cancer, particularly when the heart and the great vessels are involved. Though generally not considered indicated in this cases, surgery can be offered to highly selected patients when a radical resection is considered achievable, and neither distant nor nodal metastasis are present. Throughout the last few decades, many authors have explored the possibility for surgical resection of lung cancer involving the heart and/or the great vessels [thoracic aorta, pulmonary artery, superior vena cava (SVC)]. In this article we consider their experiences focusing on the technical aspects of the vascular reconstruction.