The 2017 Seventh World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) was held in Barcelona, Spain, from 16 to 21 July. Judging by the attendance at surgical sessions – marked by full rooms even late in the day – the interest level and enthusiasm were extraordinary. Virtually every paediatric surgical team on the planet was represented in some way, often with multiple team members in attendance.

Having accepted the task of summarising the week’s surgical activities, I did attend every surgical session that I possibly could, but, of necessity, there was considerable overlap in the programme, which made it impossible to see all presentations. Moreover, many – if not all – of the concurrent “non-surgical” sessions would have been highly relevant to most cardiac surgeons – e.g. transplantation, adult congenital heart disease-grown up congenital heart disease, imaging, humanitarian initiatives, heart failure, paediatric cardiac intensive care unit, anaesthesia, interventional cardiology, perfusion, nomenclature, and genetics. In any case, the lines between our various sub-specialties have always been somewhat indistinct, and to include all of this information in a meeting of 1 week’s duration was a daunting task. Therefore, my comments here relate to the complex and all encompassing nature of our specialty, and not in any way to the organisation of the scientific programme for the WPCCS, which was, in my opinion, first class.

The working group for the surgical portion of the 2017 programme included Drs. Carl Lewis Backer (Chicago), Emre Belli (Paris), Sertaç Çiçek (Istanbul-Rochester), Joseph A. Dearani (Rochester), J. William Gaynor (Philadelphia), Viktor Hraska (Milwaukee), Jeffrey P. Jacobs (St. Petersburg), Sano Shunji (Okayama-San Francisco), Christo Tchervenkov (Montreal), James Tweddell (Cincinnati), and Luca Vricella (Baltimore). We thank everybody for an excellent effort.

The 2017 WCPCCS programme included three notable and compelling surgical memorial sessions, in which we remembered our friends and colleagues Drs. Denton Cooley, Adib Jatene, and Juan Comas.

The actual presentation details remain freely available online and in the abstract book, and many manuscripts arising from the lectures will be published in due course in Cardiology in the Young. However, I can briefly summarise the surgical programme highlights as follows:

1. 1. Monday: surgical abstract session, surgery for coronary anomalies, hypoplastic left heart syndrome, Adib Jatene memorial lecture, surgical abstracts, surgery for HLHS, Denton Cooley memorial session (VAD workshop).

2. 2. Tuesday: surgery for coarctation and interrupted aortic arch, pulmonary conduits and pulmonary valve replacement, total cavopulmonary connection plenary session, surgical abstract session, debates with multiple surgical-medical controversies.

3. 3. Wednesday: atrioventricular septal defects, Juan Comas Memorial Session (transposition of great arteries topics), surgical poster session, aortopathy session.

4. 4. Thursday: surgery for tetralogy of Fallot, congenital aortic valve disease, Ebstein’s anomaly, plenary heart transplantation session, tetralogy and beyond.

5. 5. Friday: surgical landmark lectures by Pedro Del Nido and Vaughn Starnes, surgery and anaesthesia session.

In my opinion, an attempt to evaluate or rank the presentations in these sessions, or order them in some way by relevance or importance, would be self-serving and presumptuous. What I can say is that every session was interesting, and it was obvious to me that most presenters had spent great time and effort in preparation. Regarding relevance, in a recent survey, which the author performed for another international meeting, paediatric cardiac surgeons were polled regarding the most significant advances in our field. It is interesting to note that all of the operative and support strategies noted in that survey were discussed in detail in various WCPCCS surgical sessions.

To conclude, I would like to offer some general impressions, philosophical musings, and perspectives regarding my week at the WCPCCS, and the surgical presentations. Innovation is what drives our specialty, and the WCPCCS is an important forum for innovators. The road is not always smooth. Niccoló Machiavelli (1469–1527) said that “There is nothing more perilous nor uncertain than to take the lead in the introduction of a new order of things. The innovator has for enemies all of those who have done well under the old, and lukewarm defenders in all of those who may do well under the new”. Theodor Billroth (1829–1894), who lived centuries later, was a true “renaissance man” and perhaps one of the most important innovators in the history of surgery. Yet, at the peak of his illustrious career he maintained that “A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues. Performing an operation to the heart is tantamount to an act of prostitution in surgery or surgical frivolity”. Even today, innovation may be viewed as the sum of creativity and execution. Resistance is common, and a lack of evidence is often cited. Professor Ludwig Von Segesser, former president of the EACTS, said (in a recent presidential address at the EACTS annual meeting) that “If it is new, then there is no evidence. That is the definition of new”. How far have we actually come since that time, and how does the WCPCCS actually promote surgical innovation?

Paediatric cardiac surgery has a rich but brief history, at least on the grand scale. The pace of innovation has increased exponentially, and will continue to do so. The WCPCCS is our main forum for documentation of milestones and inflection points in this evolution, a critically important forum for clinical and basic research – the distinction between the two entities is in fact rather blurred.

There are numerous challenges in all paediatric cardiac surgical research. Only about 10% of human studies qualify as randomised-controlled trials, making results difficult to interpret and apply. Learning curves may change outcomes during the course of a study, and complex – sometimes challenge-able – Bayesian approaches may be required for analysis. Surgical procedures may themselves have a placebo effect. The WCPCCS continues to provide a friendly but sophisticated forum for presentation, real-time analysis, and discussion of the most controversial issues, and offers a true world perspective. Therefore, if innovation does drive our specialty, then the opportunity to report our work and experiences to our peers at the WCPCCS helps in many ways to drive innovation.

One of my former colleagues, a very experiences operating theatre nurse in Australia, told me that she dreaded the return of surgeons from international meetings because she knew that there would be new techniques to deal with, sometimes of questionable added value, and of course an area of concern for colleagues who did not attend the meeting. My only comment is: do try this at home, but as always proceed with caution!

In conclusion, we had an amazing week of educational initiatives, not to mention a unique opportunity to catch up with old friends and colleagues from around the world. The information presented was spectacular, and would humble even the proudest among our ranks. From a personal point of view, the WCPCCS was an important learning experience, even – or perhaps especially – for a surgeon with 30 years on the job. I am impressed by the superb quality of the surgical contributions, especially those coming from colleagues in developing and previously under-represented countries. Thanks to Sertaç and Levent, and the entire WCPCCS 2017 organising team, and to the many attendees, individuals, and organisations that helped to make the event possible. I will see you all in Washington in 2021, and until then, safe travels, and I wish you every success in your clinical, research, and humanitarian endeavours.