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–AI 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–AI 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.

Introduction: Transparency and public reporting have become central components of quality governance in cardiothoracic surgery, promoting professional accountability, supporting informed patient decision-making, and strengthening public trust. Their importance is particularly evident in a specialty characterized by technically demanding procedures and high clinical risk. Aims and Objectives: This narrative review examines the impact of public reporting of cardiothoracic surgical outcomes on clinical practice, ethical decision-making, surgeon well-being, and patient choice. It explores both the intended benefits of transparency and its potential unintended consequences. Unlike previous reviews focusing primarily on quality metrics or reporting systems, this review integrates clinical evidence with ethical analysis to propose a balanced framework for responsible transparency in cardiothoracic surgery. Materials and Methods: A narrative literature review was conducted using the PubMed and ScienceDirect databases. Relevant articles published between 2000 and 2026 were identified using the search terms “cardiothoracic surgery,” “public reporting,” “transparency,” and “risk adjustment.” Results: Public reporting has been associated with improved benchmarking, enhanced quality improvement initiatives, greater institutional accountability, and more informed patient choice. Evidence also suggests modest improvements in selected clinical outcomes. However, these benefits may be accompanied by unintended effects, including risk-averse decision-making, avoidance of high-risk cases, distortion of clinical judgment, reduced willingness to adopt innovative techniques, and potential inequities for institutions caring for more complex patient populations. Conclusions: Public reporting should evolve beyond the simple disclosure of performance metrics toward an ethically grounded model of transparency that is context-sensitive, appropriately risk-adjusted, and patient-centered. Such an approach should promote shared accountability, emphasize continuous quality improvement rather than punitive performance assessment, and incorporate expert clinical interpretation to ensure fairness, preserve innovation, and support equitable patient care.

Background: Subvalvular aortic stenosis (SAS) is an important cause of fixed left ventricular outflow tract obstruction and the second most common form of aortic stenosis. Although traditionally considered a congenital lesion, increasing evidence suggests that SAS often behaves as a progressive condition influenced by anatomical and hemodynamic factors. The disease may lead to significant complications, including left ventricular hypertrophy and progressive aortic regurgitation. Materials and Methods: A narrative review of the current literature was performed to summarize contemporary knowledge regarding the epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of subvalvular aortic stenosis. Relevant studies were identified through searches of major medical databases and were critically analyzed to provide an overview of current concepts and clinical practice. Results: Subvalvular aortic stenosis demonstrates considerable anatomical and clinical heterogeneity, ranging from discrete subaortic membranes to fibromuscular tunnel-type obstruction. The condition often progresses over time, with increasing LVOT gradients and a high incidence of associated aortic regurgitation. Echocardiography remains the primary diagnostic modality, while advanced imaging techniques provide additional anatomical detail and assist in surgical planning. Surgical resection remains the cornerstone of treatment when significant obstruction or related complications develop. Conclusions: Subvalvular aortic stenosis is a complex and progressive disease requiring careful imaging assessment and timely surgical management. Although surgical outcomes are generally excellent, recurrence and progressive aortic valve involvement remain important long-term considerations. Ongoing research aimed at improving risk stratification and optimizing surgical strategies may further enhance patient outcomes.

Introduction: Hearing loss and cognitive impairment are among the most common chronic conditions of aging, and a growing body of evidence links the two. The 2020 and 2024 Lancet Commissions identified midlife hearing loss as one of the largest potentially modifiable risk factors for dementia, raising the possibility that auditory rehabilitation could help preserve cognition. Methods: This narrative review provides a lifespan perspective by summarizing current evidence on the relationship between hearing loss and cognitive decline, the cognitive domains most affected, and the mechanisms proposed to explain the association, including the cognitive load, common cause, cascade, and overdiagnosis hypotheses, together with their neurobiological correlates. Results: We then examine the effect of auditory interventions on cognition in adults, considering hearing aids and cochlear implants separately, and discuss landmark trials such as ACHIEVE, which suggest that cognitive benefits may be greatest in older adults at increased risk of decline. Finally, we address the distinct situation of children, in whom early auditory deprivation may shape the development of working memory and executive function and in whom the timely fitting of hearing devices is critical. Conclusions: Overall, the evidence supports hearing loss as a modifiable contributor to cognitive decline and highlights early detection and rehabilitation as promising, though not universally effective, strategies for protecting cognitive health.

Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Materials and Methods: A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Results: Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusions: Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them.