Over the last 20 years, there has been a steady and consistent reduction in mortality for pediatric cardiac surgery. This improvement has occurred in spite of an increase in complexity of cases undertaken as well as a shift to surgery in infants and neonates. At many major pediatric cardiac surgery centers such as Children’s National Medical Center in Washington DC, approximately 30% of cardiac surgical patients today are neonates, 30% are infants between 1 month and 1 year of age, and the remaining are older. Even conditions such as hypoplastic left heart syndrome can now be palliated in the newborn period applying the Norwood procedure with a mortality as low as 10-15%.