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Purpose of review: To review the recent advances in neonatal cardiac surgery and identify future directions of this subspecialty of congenital heart surgery.

Recent findings: Recent advances in neonatal cardiac surgery have included the right ventricular to pulmonary artery conduit, the hybrid procedure and antegrade cerebral perfusion. In addition to refining the indications and techniques for these strategies, we can advance the field through collaborative learning between neonatal heart surgery centers. Collaborative learning is the low-hanging fruit that we can all use to advance the care of this patient population. On the horizon are a variety of strategies that will improve our management of this complex patient population. Among these improvements are better anticoagulation strategies targeting the unique hemostatic system of the neonate. The next transformative change, the next moonshot, may well be regenerative therapy that unlocks the body's ability to regenerate specific tissue such as valves and heart muscle to correct congenital defects and repair damaged muscle.

Summary: The current state of the specialty of neonatal cardiac surgery will be reviewed, and the possible future directions based on their ease and likelihood: specifically, the low-hanging fruit, what is on the horizon and the next moonshot.

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