Instructions for Authors

All research papers in the Annals of Cardiothoracic Surgery (ACS) are published Open Access thanks to the generous sponsorship from the Collaborative Research (CORE) Group. Moreover, ACS immediately fulfils the requirements of the US National Institutes of Health, the UK Medical Research Council, the Welcome Trust, and other funding bodies by making the full text of publicly funded research freely available on and forwarding it directly to be indexed on PubMed Central, the National Library of Medicine's full text archive.


Systematic Reviews with or without Meta-analyses

A comprehensive, scholarly, balanced, systematic review of evidence-based literature including all findings; these are not opinion submissions. Submissions should be state-of-the-art science confined mostly to the best available evidence. All meta-analyses of randomized trials must adhere to the guidelines outlined in the PRISMA statement, designed to improve manuscript quality 1 . Authors must include a suitable PRISMA flow chart in their submission. Further advice on suitability is available from the Editorial Office. Useful resources for authors of review articles include the article 'Systematic reviews and meta-analysis for the surgeon scientist' by Galandiuk and colleagues 2, and the Cochrane Handbook for Systematic Reviews of Interventions 3 .

ACS will consider for publication Cochrane review articles that have been substantially shortened and re-written for a surgical audience, but such submissions must state this on the title page of the manuscript, and copies of the original article must be sent to the Editorial Office for consideration. You must also apply for permission from the Cochrane Library – further information on how to do this is available in the Cochrane Manual 4 . Submissions must relate to important clinical subjects and be accompanied by author analysis leading to conclusions. The structured review must be no more than 6000 words, excluding title page, abstract, text, tables, figures, figure legends, and references. Structured abstracts are limited to 300 words.

For more details, please read through the submission guidelines for ACS Systematic Reviews with or without Meta-analyses, and browse previous examples.

Keynote Lecture

The review of the topic must be submitted together with the Keynote Lecture video file. The submitted article must contain two components – written manuscript and PowerPoint presentation.

The manuscript should be educational and authoritative, representing the state-of-the-art review of the topic. Your expert opinions and recommendations are strongly encouraged. The PowerPoint should be approx. 20mins duration and must have narration. Further guidelines are attached to this email.

For more details, please read through the submission guidelines for ACS Keynote Lecture Series, and browse previous examples.

Featured Articles

Featured articles must be original scientific reports of clinical research, including randomized controlled trials, prospective studies and large institutional or multi-institutional reports, etc. Articles must be written in proper narrative prose and should follow the IMRaD style (Introduction, Methods, Results and Discussion). Submissions that solely summarise bodies of existing published work will not be accepted. The word limit is 3000 words.

For more details, please read through the submission guidelines for ACS Featured Articles, and browse previous examples.


Editorials are generally viewpoint articles that provide new information or opinions from acknowledged experts, and can be more subjective, forward-looking, or speculative. Re-tabulations of the existing literature, without insightful discussion and analysis, are discouraged. Editorials should be structured with an Introduction and Conclusion, but do not necessarily need subheadings. The word limit is 800-1000 words, no abstract, no figures or tables, 10 references maximum. 

For more details, please read through the submission guidelines for ACS Editorials.

Art of Operative Techniques

This is an invited section that publishes illustrated articles. The body of the article should include 8-12 medical drawings or photographs, accompanied by detailed legends, describing the operative procedure in a step-by-step format. Your expert opinions regarding possible pitfalls and the comparison of the described procedure with other methods are encouraged. To ensure consistency of style, the ACS medical illustrator will work with authors to produce the artwork.

For more details, please read through the submission guidelines for ACS Art of Operative Techniques, and browse previous examples.

Masters of Cardiothoracic Surgery

"Masters of Cardiothoracic Surgery" is a featured section that publishes narrated videos provided by renowned surgeons. This section is designed to be presented as a detailed "how to" multimedia manual for operative procedures. The submitted videos of each article must have a maximal limit of one hour in duration and it must be accompanied by descriptive text. The text should include three subheadings – Case Presentation, Surgical Techniques, and Comments. The main section on Surgical Techniques should include detailed descriptions of the procedures in a step-by-step format. Expert opinions regarding possible pitfalls and the comparison of the described procedure with other methods are encouraged. We will accept digital files in MP4, Flash video (.flv), MPEG (MPEG video file), mov, avi, and wmv formats or videos on CD/DVD. The corresponding author must confirm in the Copyright Transfer Agreement, that he/she has received a signed release form from each patient recorded on the submitted video. Patients must not be identifiable in these videos. If required, additional video editing by the authors, including the insertion of a voice-over, may also be requested by the ACS Editorial Office.

For more details, please read through the submission guidelines for ACS Masters of Cardiothoracic Surgery, and browse previous examples.

Your Comments

The Editors welcome letters related to papers and multimedia articles previously published in ACS. These can be submitted online in response to a specific article. The authors of the original publication may be given the opportunity to respond in the same issue of ACS. Letters and responses must not exceed 500 words in length, must be limited to three authors and five references, and should not have tables or figures.


The length of manuscripts must strictly adhere to the specifications under the section Manuscript Categories. Manuscripts should be presented in the following order: (i) title page, (ii) abstract and key words, (iii) text, (iv) acknowledgments, (v) disclosure, (vi) references, (vii) supplementary material, (viii) figure legends, (ix) tables (each table complete with title and footnotes) and (x) figures. Footnotes to the text are not permitted and any such material should be incorporated into the text as parenthetical matter.

Title Page

The title page should contain (i) the title of the manuscript. Authors should include all information in the title that will make electronic retrieval of the article both sensitive and specific. (ii) the full names of the authors and (iii) the addresses of the institutions at which the work was carried out together with (iv) the full postal and email address, plus facsimile and telephone numbers, of the corresponding author. The present address of any author, if different from that where the work was carried out, should also be supplied. In keeping with the latest guidelines of the International Committee of Medical Journal Editors, each author's contribution to the paper is to be quantified. The title should be short, informative and contain the major key words so that readers and online users will identify the article easily in online search. Do not use abbreviations in the title. A short running title (less than 40 characters) must also be provided.

Abstract and Keywords

The length of all abstracts is limited to 300 words, and should be either structured or non-structured according to the Submission Guidelines for the specific categories. It must be factual and comprehensive. The use of abbreviations and acronyms should be limited and general statements (e.g. "the significance of the results is discussed") should be avoided.

Three to five key words should be supplied below the abstract, and should be taken from those recommended by the US National Library of Medicine’s Medical Subject Headings (MeSH) browser list at:


Authors should follow the recommended headings to standardize article structures. This will ensure consistent formats and styles between articles, as well as improving ease of readability. Suggested discussion points are also provided in the Guidelines.


This should include sources of support, including federal and industry support. All authors who have contributed to the manuscript must be acknowledged. Medical writers, proof-readers and editors should not be listed as authors, but acknowledged at the end of the text.


At the time of submission, each author must disclose and describe any involvement, financial or otherwise, that might potentially pose a conflict of interest. Disclosure must be included in the text of the manuscript.


The Vancouver system of referencing should be used. In the text, references should be cited using superscript Arabic numerals in the order in which they appear. If cited in tables or figure legends, number according to the first identification of the table or figure in the text. In the reference list, cite the names of all authors when there are six or fewer; when seven or more, list the first three followed by et al. Do not use ibid. or op cit. Reference to unpublished data and personal communications should not appear in the list but should be cited in the text only (e.g. Smith A, 2000, unpublished data). All citations mentioned in the text, tables or figures must be listed in the reference list. Names of journals should be abbreviated in the style used in Pubmed. Authors are responsible for the accuracy of the references.


Tables should be self-contained and complement (but not duplicate) information contained in the text. Number tables consecutively in the text in Arabic numerals. Type tables on a separate page with the title above. Titles should be concise but comprehensive - the table, title and footnotes must be understandable without reference to the text. Column headings should be brief, with units of measurement in parentheses; all abbreviations must be defined in footnotes. Footnote symbols: †, ‡, §, ¶, should be used (in that order) and *, **, *** should be reserved for P-values. Statistical measures such as SD or SEM should be identified in the headings. If tables have been reproduced from another source, a letter from the copyright holder (usually the Publisher), stating authorization to reproduce the material, must be attached to the covering letter, and must also be referenced in the table footnote.


All illustrations (line drawings and photographs) are classified as figures. Figures should be cited in consecutive order in the text. Magnifications should be indicated using a scale bar on the illustration. If figures have been reproduced from another source, a letter from the copyright holder (usually the Publisher), stating authorization to reproduce the material, must be attached to the covering letter, and must also be referenced in the figure legend.

- Size: Figures should be sized to fit within the column (82 mm), intermediate (118 mm) or the full text width (173 mm).

- Resolution: Figures must be supplied as high resolution saved as .eps or .tif. Halftone figures 300 dpi (dots per inch), Color figures 300 dpi saved as CMYK, figures containing text 400 dpi, Line figures 1000 dpi.

- Color figures: Files should be set up as CMYK (cyan, magenta, yellow, black) and not as RGB (red, green, blue) so that colors as they appear on screen will be a closer representation of how they will print in the Annals.

- Line figures: Must be sharp, black and white graphs or diagrams, drawn professionally or with a computer graphics package.

- Text sizing in figures: Lettering must be included and should be sized no larger than the journal text or 8 point (Should be readable after reduction – avoid large type or thick lines). Line width between 0.5 and 1 point.

- Figure legends: Type figure legends on a separate page. Legends should be concise but comprehensive – the figure and its legend must be understandable without reference to the text. Include definitions of any symbols used and define/explain all abbreviations and units of measurement.

Figures which are deemed of unsatisfactory quality for publication at the discretion of the Editorial Office will be returned to the author for amendment.


Videos can be submitted with a manuscript online. For fast uploads please attach your file(s) as compressed .zip or .sit files on the ACS website. Once upload has been initiated, do not close the window until you have received on screen confirmation that your upload has been successful. Please note that the maximum size of each file has a limit of 2GB. If your file(s) for submission are greater than this limit, please divide the file into multiple segments, with the file names labelled in the correct order. Please contact the Editorial Office if assistance is required.

ACS will accept digital files in mp4, flash video (.flv), MPEG (MPEG video file), DVD video format, mov, avi, and wmv formats or videos on CD/DVD. We recommend using H.264/mp4 for the video codec and AAC for the audio codec. Contributors are asked to be succinct, and the Editor-in-Chief reserves the right to require shorter video duration. Legends for the video segments should be placed at the end of the article. The video should be of high quality (resolutions: 1080P: 1,920×1,080; 720P: 1,280×720P). The video should demonstrate the descriptions in the text of the manuscript. The corresponding author must confirm in the Copyright Transfer Agreement, that he/she has received a signed release form from each patient recorded on the submitted video. Ideally, patients should not be identifiable in these videos. If required, additional video editing by the authors, including the insertion of a voice-over may also be requested.


Equations should be numbered sequentially with Arabic numerals; these should be ranged right in parentheses. All variables should appear in italics. Use the simplest possible form for all mathematical symbols.

Supplementary Files

ACS accepts supplementary files that will enhance the content of your research and manuscript, to be published in online version only. This may be in the form of movies, animation sequences, additional images, sound clips, and more. Authors must submit the material along with the article, and acceptance will be at the discretion of the Editors-in-Chief. Supplementary material must follow the above set-out criteria, or otherwise be concisely described as per a succinct caption. For more information, please contact the ACS Editorial Office.


At the time of submission, the submitting author must include a disclosure statement in the body of the manuscript. The statement should include whether the authors have published or submitted the manuscript elsewhere. The statement will also describe all of the authors’ relationships with companies that may have a financial interest in the information contained in the manuscript. This information should be provided under the heading titled 'Disclosure', which should appear after the ‘Acknowledgement’ section and before the 'References' section. The absence of any interest to disclose must also be stated. In addition, any financial interests must be detailed in the Financial Disclosure form, which will be provided to the corresponding author upon acceptance for distribution to each author.


Authors must state that the protocol for the research project has been approved by a suitably constituted Ethics Committee of the institution within which the work was undertaken and that it conforms to the provisions of the Declaration of Helsinki (as revised in Edinburgh 2000), available at: The Annals retains the right to reject any manuscript on the basis of unethical conduct of either human or animal studies. All investigations on human subjects must include a statement that the subjects gave informed consent. Patient anonymity should be preserved. Photographs need to be cropped sufficiently to prevent human subjects being recognized (or an eye bar should be used).

In general, submission of a case report should be accompanied by the written consent of the subject (or parent/guardian) before publication; this is particularly important where photographs are to be used or in cases where the unique nature of the incident reported makes it possible for the patient to be identified. While the Editorial Board recognizes that it might not always be possible or appropriate to seek such consent, the onus will be on the authors to demonstrate that this exception applies in their case. Any experiments involving animals must be demonstrated to be ethically acceptable and where relevant conform to national guidelines for animal usage in research.


We require, as a condition of consideration for publication, registration in a public trials registry. Trials must register at, or before, the onset of patient enrollment. This policy applies to any clinical trial starting enrollment after January 1, 2006. For trials that began enrollment before this date, we require registration by April 1, 2006, before considering the trial for publication. We define a clinical trial as any research project that prospectively assigns human subjects to intervention or comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (e.g., phase 1 trials) are exempt.

We do not advocate one particular registry, but registration must be with a registry that meets the following minimum criteria: (1) accessible to the public at no charge; (2) searchable by standard, electronic (Internet-based) methods; (3) open to all prospective registrants free of charge or at minimal cost; (4) validates registered information; (5) identifies trials with a unique number; and (6) includes information on the investigator(s), research question or hypothesis, methodology, intervention and comparisons, eligibility criteria, primary and secondary outcomes measured, date of registration, anticipated or actual start date, anticipated or actual date of last follow-up, target number of subjects, status (anticipated, ongoing or closed) and funding source(s).

Registries that currently meet these criteria include: (1) the registry sponsored by the United States National Library of Medicine (; (2) the International Standard Randomized Controlled Trial Number Registry (; (2) the Australian Clinical Trials Registry (; (4) the Chinese Clinical Trials Register (; and (5) the Clinical Trials Registry - India (


Reporting of randomized controlled trials should follow the guidelines of The CONSORT Statement:

Papers accepted for publication in the Annals become copyright of ACS and the corresponding author will be asked to sign a transfer of copyright form on behalf of all authors. In signing the transfer of copyright, it is assumed that authors have obtained permission to use any copyrighted or previously published material. All authors must read and agree to the conditions outlined in the Copyright Assignment Form, and the corresponding author can sign on their behalf. Acceptance of a manuscript is contingent upon receipt of a signed Copyright Assignment Form.


Manuscripts must follow the style of the Vancouver agreement detailed in the International Committee of Medical Journal Editors’ revised 'Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication', as presented at:

Author name

Each author's given name should be followed by his/her surname. Capitalize each letter of the surname. A hyphen could be used in surname according to the rule in the Author's region. Capitalize the first letter of those words/syllables that they hope to be abbreviated in their given name, otherwise, DO NOT capitalize the first letter and use a hyphen to connect it with its anterior word.


The Annals uses US spelling and authors should therefore follow the latest edition of the Merriam–Webster’s Collegiate Dictionary.


All measurements must be given in SI or SI-derived units. For more information about SI units, please go to the Bureau International des Poids et Mesures (BIPM) website at:


Must be used sparingly – only where they ease the reader’s task by reducing repetition of long, technical terms. Initially use the word in full, followed by the abbreviation in parentheses. Thereafter use the abbreviation only.

Trade names

Drugs should be referred to by their generic names. If proprietary drugs have been used in the study, refer to these by their generic name, mentioning the proprietary name, and the name and location of the manufacturer, in parentheses.


Supporting Information is provided by the authors to support the content of an article but they are not integral to that article. They do not appear in the print version of the article. Supporting Information must be submitted together with the article for review; they should not be added at a later stage. They can be in the form of tables, figures, appendices and video footage. Reference to Supporting Information in the main body of the article is allowed. However, it should be noted that excessive reference to an item listed as. Supporting Information may indicate that it would be better suited as a proper reference or fully included figure/table. The materials will be published as they are supplied and will not be checked or typeset in any way. All Supporting Information files should be accompanied by a legend, listed at the end of the main article. Each figure and table file should not be larger than 5MB, although video files may be larger.


General Requirements

All articles submitted to the Annals must comply with these instructions. Failure to do so will result in return of the manuscript and possible delay in publication.

• Submissions must be double-spaced.
• All margins should be at least 30 mm.
• All pages should be numbered consecutively in the top right-hand corner, beginning with the title page.
• Do not use Enter at the end of lines within a paragraph.
• Turn the hyphenation option off; include only those hyphens that are essential to the meaning.
• Specify any special characters used to represent non-keyboard characters.
• Take care not to use l (ell) for 1 (one), O (capital o) for 0 (zero) or ß (German esszett) for (Greek beta).
• Use a tab, not spaces, to separate data points in tables. If you use a table editor function, ensure that each data point is contained within a unique cell (i.e. do not use carriage returns within cells).

Each figure should be supplied as a separate file, with the figure number incorporated in the file name. For submission, low-resolution figures saved as .jpg or .bmp files should be uploaded, for ease of transmission during the review process. Upon acceptance of the article, high-resolution figures (at least 300 dpi) saved as .eps or .tif files should be uploaded. Digital images supplied only as low-resolution files cannot be used for publication.

Cover Letter

Papers are accepted for publication in ACS based on the understanding that the content has not been published or submitted for publication elsewhere except as a brief abstract in the proceedings of a scientific meeting or symposium. This must be stated in the covering letter. The covering letter must also contain an acknowledgment that all authors have contributed significantly, and that all authors are in agreement with the content of the manuscript. In keeping with the latest guidelines of the International Committee of Medical Journal Editors, each author’s contribution to the paper is to be quantified.


The reviewers' evaluations and Associate Editor's comments are compiled by the Editor-in-Chief for disposition and transmission to the authors. A decision is usually made within four weeks of submission of the manuscript.

The Editor-in-Chief will advise authors whether a manuscript is accepted, should be revised or is rejected. Minor revisions are expected to be returned within two weeks of the decision; major revisions within four weeks. Manuscripts not revised within these time periods are subject to withdrawal from consideration for publication unless the authors can provide proof of extenuating circumstances.

A number of manuscripts will have to be rejected on the grounds of priority and available space. A manuscript may be returned to the authors without external review if the Editor-in-Chief and the Associate Editor find it inappropriate for publication in the Annals. Similarly, the Editors may expedite the review process for manuscripts felt to be of high priority in order to reach a rapid decision. Such ‘fast-track decisions’ will normally occur within one week of receipt of the manuscript.

Authors may recommend preferred reviewers by providing the Editor-in-Chief with the names, addresses and email addresses of up to three suitably qualified individuals of international standing. However, the Editor-in-Chief will not be bound by any such nomination. Likewise, authors may advise of any individual who for any reason, such as potential conflict of interest, might be inappropriate to act as a referee, again without binding the Editor-in-Chief.

The Editor-in-Chief's decision is final. However, if the authors dispute a decision and can document good reasons why a manuscript should be reconsidered, a rebuttal process exists. In the first incidence, authors should write to the Editor-in-Chief.

All manuscripts should be written in a clear, concise, direct style so that they are intelligible to the professional reader who is not a specialist in the particular field. Where contributions are judged as acceptable for publication, the Editor and the Publisher reserve the right to modify manuscripts to eliminate ambiguity and repetition to improve communication between the author and the reader. If extensive alterations are required, the manuscript will be returned to the author for revision.


It is essential that corresponding authors supply an email address to which correspondence can be emailed while their article is in production. Notification of the URL from where to download a Portable Document Format (PDF) typeset page proof, associated forms and further instructions will be sent by email to the corresponding author. The purpose of the PDF proof is a final check of the layout tables and figures. Alterations other than the essential correction of errors are unacceptable at PDF proof stage. The proof should be checked, and approval to publish the article should be emailed to the Publisher by the date indicated, otherwise, it may be signed off by the Editor or held over to the next issue. Acrobat Reader will be required in order to read the PDF. This software can be downloaded (free of charge) from the following web site: This will enable the file to be opened, read on screen, and printed out in order for any corrections to be added. Further instructions will be sent with the proof.


Minimum orders of 50 offprints will be provided upon request, at the author's expense. Please email


All invited articles are free of charge. Authors are required to pay an article processing charge for free submissions. This fee is 2390 USD if the manuscript is accepted. This Article Processing Charge policy is valid from March 1st, 2019.


Author Services enables authors to track their article, once it has been accepted, through the production process to publication online and in print. Authors can check the status of their articles online and choose to receive automated emails at key stages of production so they do not need to contact the production editor to check on progress.


ACS offers Accepted Articles service for selected articles. Accepted Articles are complete full-text articles published online in advance of their publication in a printed issue. Articles are therefore available as soon as they are ready, rather than having to wait for the next scheduled print issue. Accepted Articles have been fully reviewed and approved for publication, but has yet to undergo copy-editing and proof correction. They are therefore given a Digital Object Identifier (DOI), which allows the article to be cited and tracked before it is allocated to an issue. After print publication, the DOI remains valid and can continue to be used to cite and access the article. More information about DOIs can be found at


For more information, visit the journal home page at: For any questions, please contact our Editorial Office by e-mail:


  1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Open Med 2009; 3(3): 123-130.
  2. Mahid SS, Hornung CA, Minor KS, Turina M, Galandiuk S. Systematic reviews and meta-analyses for the surgeon scientist. Br J Surg 2006; 93: 1315-1324.
  3. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions (formerly the Reviewers' Handbook). [accessed 2 July 2007].
  4. The Cochrane Collaboration. The Cochrane Manual, Issue 3, 2007. [updated 24 May 2007].

Updated on March 11th, 2019