The focus of the reports reviewed in the last year has shifted to "outcomes," perhaps in response to the pressures of national health care reform. With regards to the extracorporeal circulation requisite for complex cardiac repair, emphasis is placed on anticoagulation management, blood use and its systemic effects, cognitive outcome after cardiac operations, and the requirement and effects of intra-aortic balloon pumping on weaning from bypass. Additionally, interest in the systemic effects of prolonged warm perfusion consequent to the novel myocardial management strategy of warm cardioplegia is evident. Advances in cardioplegia have shifted predominantly toward additives, with specific emphasis on modulating inflammation, enhancing the metabolic substrate, and limiting toxic oxygen free radical injury and the ischemia-induced accumulation of cations.