{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:05:51Z","timestamp":1790071551416,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Artificial intelligence (AI) is moving rapidly from retrospective prediction and image analysis into treatment selection, operative planning, intraoperative guidance, and postoperative prognostication in cardiothoracic surgery. This transition raises an ethical problem that cannot be resolved by model accuracy alone: when an algorithm begins to shape a high-stakes clinical decision, the distribution of knowledge, authority, and responsibility also changes. This review synthesizes cardiothoracic and closely related medical evidence available through August 2026, with emphasis on quantitative performance, human\u2013AI interaction, bias, patient autonomy, and liability. The available evidence is simultaneously encouraging and cautionary. Machine-learning approaches can improve predictive performance and AI-assisted thoracic planning can reduce errors and increase procedural consistency; however, these gains have not consistently translated into superior patient outcomes. Human\u2013AI studies similarly demonstrate that improved accuracy may coexist with automation bias and overacceptance of algorithmic recommendations. Evidence of demographic performance disparities and limitations in the representativeness of training and validation datasets further raises concerns regarding fairness and equitable access to care. On this basis, we argue that cardiothoracic AI should be governed according to the level of decision influence rather than by technology type alone. We distinguish non-delegable professional duties, distributed system responsibilities, and non-transferable patient authority, and propose an Ethical Heart Team Framework for converting algorithmic output into ethically defensible clinical action.<\/jats:p>","DOI":"10.3390\/medsci14050586","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:04:17Z","timestamp":1790067857000},"page":"586","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial Intelligence and the Ethical Foundations of Cardiothoracic Surgery: Evidence, Accountability, and the Limits of Delegated Judgment"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-0059","authenticated-orcid":false,"given":"Vasileios","family":"Leivaditis","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-2628","authenticated-orcid":false,"given":"Francesk","family":"Mulita","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2445-0879","authenticated-orcid":false,"given":"Vasiliki","family":"Androutsopoulou","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital of Larissa, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0606-7287","authenticated-orcid":false,"given":"Sofoklis","family":"Mitsos","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Tomos","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2779-5398","authenticated-orcid":false,"given":"Ioannis","family":"Panagiotopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Nikolakopoulos","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Liolis","sequence":"additional","affiliation":[{"name":"Department of Oncology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-5361","authenticated-orcid":false,"given":"Theodora","family":"Skoura","sequence":"additional","affiliation":[{"name":"Medical School, National and Kapodistrian University of Athens (NKUA), Aretaeion Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-4047","authenticated-orcid":false,"given":"Efstratios","family":"Koletsis","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Khodaveisi, T., Aslani, N., Amiri, P., Kamrani, F., and Saeedi, S. 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