STATE OF THE ART PAPER
Calculated courage: risk, responsibility, and the ethos of cardiac surgery in the age of artificial intelligence
1
Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
2
Department of Cardiothoracic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
3
Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
4
Department of Electrical and Computer Engineering, Democritus University of Thrace, Xanthi, Greece
5
Department of Oncology, General University Hospital of Patras, Greece
6
John Radcliffe Hospital Emergency Department, University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
7
Department of Vascular Surgery, General University Hospital of Patras, Greece
8
Department of Surgery, General Hospital of Eastern Achaia - Unit of Aigio, Greece
9
Medical School, National and Kapodistrian University of Athens (NKUA), Aretaeion Hospital, Athens, Greece
10
Department of Surgery, General University Hospital of Patras, Greece
11
Department of Surgery, General Hospital of Lamia, Greece
12
Postgraduate Health and Social Care Management Program, Department of Business Administration, University of West Attica, Athens, Greece
13
Second Department of Surgery, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
These authors had equal contribution to this work
Submission date: 2026-01-11
Final revision date: 2026-03-15
Acceptance date: 2026-04-12
Publication date: 2026-06-30
Corresponding author
Francesk Mulita
Second Department of Surgery Medical School Democritus University of Thrace, 68100 Alexandroupolis, Greece
Second Department of Surgery Medical School Democritus University of Thrace, 68100 Alexandroupolis, Greece
Arch Med Sci Atheroscler Dis 2026;11(1):123-148
KEYWORDS
artificial intelligencerisk assessmentcardiac surgerypredictive modellingsurgical ethicsmoral responsibilityalgorithmic decision-makingcalculated courage
TOPICS
ABSTRACT
The history of cardiac surgery reflects a unique interplay between technological innovation and moral responsibility. From the early era of experimental open-heart operations to the present age of data-driven precision, the discipline has continually redefined its understanding of risk, agency, and ethical duty. This review examines the historical, ethical, and philosophical evolution of cardiac surgery, focusing on how artificial intelligence (AI) and predictive modeling are reshaping the surgeon’s role and professional ethos. A narrative synthesis of literature was conducted, including studies on surgical risk assessment, AI-assisted decision-making, and the ethical implications of automation. Inclusion criteria encompassed articles addressing historical development, risk quantification, moral responsibility, and algorithmic ethics within cardiac and cardiothoracic surgery. Artificial intelligence augments, but cannot replace, the ethical and interpretive dimensions of cardiac surgery. Future progress depends on aligning technological sophistication with moral wisdom, ensuring that as machines grow more intelligent, the humanity of surgical practice endures.
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