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At the time of data collection, formal ethics committee approval was not routinely required for retrospective clinical studies at the institution. The study was conducted in accordance with the principles of the Declaration of Helsinki. All data were fully anonymized prior to analysis, and no patient-identifiable information was used. Given the retrospective design and anonymized data, the requirement for individual informed consent was waived.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All scientific content, clinical data, statistical analyses, interpretations, and conclusions are solely the author\u2019s own work.","order":2,"name":"Ethics","label":"AI Assistance Disclosure","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript is based on the author's specialist surgical thesis (uzmanl\u0131k tezi), completed at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital in 2007. At the time of completion, prevailing academic appointment criteria in Turkey did not require or incentivize the publication of residency theses in peer-reviewed journals; consequently, this work remained unpublished for an extended period. The clinical data and core findings are original and unchanged from the thesis. For the present submission, the manuscript has been updated in accordance with current reporting standards (STROCSS 2025), and the reference list has been supplemented with recent landmark trials, systematic reviews, and meta-analyses published between 2019 and 2024 to contextualize the original findings within the current evidence base.","order":3,"name":"Ethics","label":"Author's Note on publication history","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"537"}}