The 2009 literature in cardiovascular surgery was characterized by several pivotal reports that will affect patient care and future trial design for years to come. The purpose of our annual review is to highlight key contributions in the field that focus on strategies and outcomes in cardiovascular surgery that practicing cardiovascular specialists will find both informative and useful in their daily practice. Particular emphasis this year was placed on articles that compare surgical with nonsurgical alternative treatment strategies or those that emphasize potential advances in specific surgical strategies. Our goal as always is to provide readers of the Journal with a succinct summary of specific studies organized around general categories, with pointed comments to highlight special significance or methodological limitations that cardiologists should consider in their pursuit of stateof-the-art care for their patients.