Domenico (Dom) Pagano was a consultant cardiothoracic surgeon at the Queen Elizabeth Hospital, Birmingham and a professor of medicine at the University of Birmingham. He was born in Pompei, Italy, where he received a classical education including philosophy, of which he was rightly proud. After school he studied medicine in Naples, graduating cum laude in 1987. He then embarked on cardiovascular surgical training in Bologna, where he met his future wife, an English teacher named Donna. In 1989 they moved to England together, settling in Stoke-on-Trent. Here he embarked on UK surgical training, dropping down the ladder to restart as a house officer in surgery. Two years later, in 1991, he progressed to the Birmingham surgical registrar rotation, gaining his FRCS in 1992. He then switched to become a senior house officer in cardiothoracic surgery at the Queen Elizabeth Hospital in Birmingham, where he made his mark, joining the West Midlands training scheme in cardiothoracic surgery and becoming a consultant at the Queen Elizabeth Hospital in 2002. Dom’s father was in agriculture, running a successful seed business in Naples. He was strict, imbuing in Dom an immutable sense of right and wrong. This was softened by his grandmother, who developed in him a lifelong interest in cooking, which was to be supplemented later in life with an encyclopaedic knowledge of wines and a treasured, eclectic wine cellar. His classical education gave him an analytical approach to everything including surgery. His early research focused on the identification of hibernating myocardium using positron emission tomography, working closely with a fellow Italian Paolo Camici, a British Heart Foundation professor of cardiology at Hammersmith Hospital. This research led to a Hunterian professorship and an MD. He went on to conduct several medium scale clinical trials largely around myocardial metabolism and protection. His understanding of research and analytical methods made him, on the one hand, an excellent and popular surgical trainer with outstanding surgical results, but on the other led him into conflict with peers less well versed in the cardiac surgical literature, particularly at multidisciplinary team meetings. Not long after he became a consultant his wife, Donna, died tragically, leaving him a single parent to his daughters Marie-Claire and Beatrice while they were still young. A loving and caring parent, Domenico did all in his power to support them through challenging times and was fiercely proud of them, considering them his greatest achievement in life. This tragedy also drove his professional determination to make a difference. He published over 150 research papers during his career. It was in the subject of health policy and guidelines where he particularly made his mark, advancing the clinical quality agenda in his own hospital, and addressing several very controversial topics. These included studying the increased risk facing patients who were admitted to hospital at the weekend and duality of interest in clinical guidelines, especially those developed by clinical societies including the European Association for Cardio-Thoracic Surgery (EACTS), of which he became secretary general in 2017. Corruption and professional self-interest were anathema to him, and he was fearless in calling them out, often making enemies in the process. ‘Never whisper in the presence of wrong’ was one of his favourite quotes. During this time he also struggled with modernising EACTS, financially and professionally, in part because of the coronavirus pandemic, in part because of his style and in part due to resistance to change in a complex multinational society. He eventually stepped down from the role due to a combination of dissatisfaction at the pace of change and his own deteriorating health. He loved the values of the NHS. He was appalled by the departure of the UK from the European Union, which made him reflect on his time in Stoke, which he felt was tainted by a perception that he was treated as an inferior Italian; treatment he later referred to as racist. Domenico loved his family, wine, good food and Juventus Football Club. Although he lived in England through love for his daughters and the NHS, his heart remained firmly in his beloved Italy, where he now lies in a crypt overlooking the Bay of Naples facing the sun. He was survived by his daughters, his sister Anna and his father Carlo.