For many years, surgeons have been able to implement new techniques and treatments with minimal oversight. Although regulatory control over application of new strategies for treatment is far different today, surgeons have enjoyed a greater degree of freedom than other specialists. The laboratory of the surgeon, and particularly the congenital cardiac surgeon, is often the operating room, since appropriate animal models are not available. Thus, the congenital cardiac surgeon has often been stimulated to modify existing techniques, or create new surgical approaches, to improve the perceived limitations of previously known surgical strategies.1 The introduction of a new surgical technique has often taken the strong ego and persistence of a surgical innovator, and has subjected the surgeon to criticism from medical colleagues. Although innovation is a proud heritage of the development of congenital cardiac, it now seems appropriate, as we are more cognizant of the past accomplishments in the development of repairs for congenital cardiac malformations, to evaluate how surgical techniques become widely adopted, often with only minimal data to suggest improvement over previously accepted procedures.