It has been 14 years since the publication of the 5th Edition of Operative Cardiac Surgery by Gardner and Spray. e 5th Edition contained 60 separate chapters dealing with the full spectrum of adult and pediatric cardiac surgery techniques and procedures that encompassed the specialty in the early 2000s. In order to encompass the entire range of adult and pediatric cardiac surgery today, the 6th Edition contains 68 chapters reecting the progress of cardiac surgery in multiple areas over the past 14 years. e section on surgery for ischemic heart disease now includes a new chapter on robotic total endoscopic coronary artery graing (TECAB). e section on valvular heart disease has been expanded to include new chapters on TAVR, valve sparing aortic root replacement and tricuspid valve surgery. e section on heart failure has been expanded to include a new chapter on temporary mechanical assistance, including ECMO for the treatment of cardiogenic shock, and surgery for hypertrophic cardiomyopathy. We have also decided to include a chapter on lung transplantation since lung transplantation is done largely by cardiothoracic surgeons today. e section on thoracic aortic disease has been expanded to include new chapters on thoracic endovascular aortic repair (TEVAR), hybrid aortic arch repair, as well as including a discussion on Type B aortic dissections. Finally, the section on cardiac rhythm disorders now includes a separate chapter on the Maze procedure for the treatment of atrial fibrillation. In addition to these many new chapters, all our chapters have been largely rewritten with new illustrations and by a new set of authors who are currently experts in the Field. In the section on congenital heart disease, the previous chapters from the 5th Edition have remained and new chapters have been added on aortic pulmonary window; cardiac transplantation for congenital heart disease; lung and heart/ lung transplantation for congenital heart disease; ventricular assist devices for congenital heart disease; congenital mitral valve repair and aortic valve repair. e new edition continues to distinguish itself in its outstanding illustrations that accompany every chapter with detailed descriptions of the operative procedures. is addition continues the tradition of utilizing brilliant art work and illustrations that clearly reect the anatomic and technical features of each operative procedure.