Over the last several decades, the risk profile and severity index of patients undergoing cardiac surgery has increased as cardiac surgery has become more sophisticated. Cardiac surgical patients in the twenty-first century are older, have greater disease burden, and possess diminished physiologic reserve, including decreased ventricular function. Many of these patients have already undergone prior cardiac interventions (i.e., percutaneous cardiac device) and need additional, more complex surgical procedures. Consequently, these patients are at risk for developing major postoperative complications. Recognition and management of these complications are paramount to the cardiac anesthesiologist and intensivist.