It is my pleasure to introduce the 2013 edition of the Pediatric Cardiac Surgery Annual. The overarching theme is “neonatal cardiac surgery.” While many pediatric cardiac surgical procedures have been well worked out and our overall outcomes have improved to the point that “mortality” is no longer useful as a statistical variable (because it occurs so rarely), neonatal cardiac repairs remain the last bastion of true surgical prowess. Nowhere is it truer that the technical outcome achieved by the surgeon at the time of exit from the operating room will determine the clinical outcome to an enormous degree. Perfection has to be the goal every time, and experienced intensivists will agree that a perfect repair will often guarantee a smooth and uneventful postoperative course. Even modest and temporary intraoperative mishaps, such as phrenic nerve, recurrent laryngeal nerve palsy, extended time of cardiopulmonary bypass, or imperfect myocardial protection, will affect neonates to a disproportionate amount, prevent timely extubation, result in the inability to close the chest, etc. Thus, neonatal cardiac repairs are the last frontier, and I wanted to focus on this group and provide experts the opportunity to weigh in on some controversial areas.
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