Guide for Authors

Contact and Manuscript Submission

G. Alexander Patterson, MD
Editor, The Annals of Thoracic Surgery
The Society of Thoracic Surgeons
633 N St. Clair Street, 21st Floor
Chicago, IL 60611-3658
PHONE: (312) 202-5808
FAX: (312) 268-5263
Manuscript submission:

Table of Contents

1. General Description of Content
2. Manuscript Submission
3. General Information for Formatting Manuscripts
4. Categories of Manuscripts and Word Limits
5. Order of Content Within Manuscripts
     Title Page
     Abstract, Graphical/Visual Abstract
     Acknowledgments and Disclosures
     Figure Legends
     Supplemental Material
6. Protection of Human and Animal Subjects
7. Conditions for Publication Form
8. Permissions
9. Miscellaneous

1. General Description of Content

The Annals of Thoracic Surgery publishes original articles on topics in thoracic and cardiovascular surgery, features such as case reports, "how to do it" articles, and image reports, as well as new technology evaluations, STS workforce reports, clinical practice guidelines, review articles, articles on our surgical heritage, special reports, book reviews, invited editorials, correspondence, commentaries and four continuing medical education (CME) activities each month. The electronic issue posted at is the journal of record.

2. Manuscript Submission

  • All manuscripts must be submitted at Authors must be registered on the site to submit manuscripts online. Every submission, regardless of category, must include: a cover letter, indicating the category of article (see below); the complete manuscript, including title page, abstract, text, tables, acknowlegments, required disclosures (see below), references and illustrations.

  • Manuscripts submitted may not have been previously published in print or electronic format, and cannot be under consideration by another publication or medium.

  • A Conditions for Publication Form, which includes disclosures of individual conflicts of interest and author contributions to the study, must be signed by all authors. The signed Conditions for Publication Form should be sent by email ( or fax (312-268-5263).

  • Written permission from the publisher (copyright holder) is required to reproduce any previously published table(s); illustrations(s) or photograph(s) in both print and electronic media. Written permission from any patients (masked or unmasked) appearing in photographs is also required.

3. General Information for Formatting Manuscripts

  • Prepare manuscripts in Microsoft Word using 11 point Arial or Times New Roman fonts. Do NOT submit your manuscript in PDF format, as it cannot be processed by the online manuscript tracking system. Manuscripts should be typed double-spaced throughout (including title page, abstract, text, references, tables, and legends) with one inch (2.5 cm) margins all around.

  • Arrange manuscript as follows: (1) title page, (2) abstract, (3) text, (4) acknowledgments, (5) disclosures if required, (6) references (do not use EndNotes), (7) tables, and (8) figure legends. Number pages consecutively, beginning with the title page as page 1 and ending with the page of figure legends. Do not use manuscript line numbers. Do not embed tables in the body of the text; they should appear after the references. "Order of Content Within Manuscripts" is described below in Section 5.

  • The title page elements include name and degree information for all authors, and their institutional affiliations and roles, acknowledgments (if appropriate); funding statement, statements regarding conflicts and/or competing interest; and information on any prior or related publications, and prior abstract/poster presentation, as well as the contact information for the corresponding author.

  • Each figure should be uploaded according to the specifications in Illustrations (Section 5) as an image file, separate from the manuscript file. The system will generate a single PDF for review purposes that includes your manuscript file and any image files.

  • Supplemental material (including any supplemental tables, text, figures, or videos) can be entered as part of the submission process at More information on uploading supplemental material is described in “Supplemental Material” (Section 5).

  • American English spelling should be used throughout the manuscript, including within illustrations.

All New Technology papers require an Acknowlegement, which discloses funding resources and includes a freedom of investigation statement.

Feature Articles:

The Annals publishes feature articles (Case Reports, How to Do Its, and Images in Cardiothoracic Surgery) online only. The title and authors of feature articles are listed in the print Table of Contents, and the articles appear in full only in the online edition of The Annals at and on ScienceDirect. Online feature articles are referenced and cited the same as print articles, and are indexed in Medline and other secondary services. The Editor may designate an article to appear in print from time to time.

Case reports should have both high clinical and educational value, and should contain novel information for our readers. While a case may be rare, if it does not contain unreported presentations, diagnoses, and/or management of a new and emerging disease, it is likely not of high enough priority for publication in The Annals. In addition, Case Reports should NOT be combined with any reviews of the literature.

How to Do It articles should be a description of a useful surgical technique and contain descriptive, illustrative material describing the innovation.

Images in Cardiothoracic Surgery showcase interesting photographs or images (CTs, MRIs, polysomnographic tracings, OR setups, etc) from unusual cases.

Clinical Practice Guidelines (CPG) are usually, but not exclusively developed by the STS Workforce on Evidence Based Surgery. CPGs, but not consensus documents or reviews, will have an Executive Summary that includes “levels of evidence” for recommendations after the list of author names in lieu of an abstract. The Executive Summary may be up to 1000 words (which are included in the word count limit). The total word limit for guidelines is 6500 words and the number of references should not exceed 80. Peer review is at the discretion of the editor. The final document must be endorsed by the STS Board of Directors.

Consensus documents originate from one or more self-appointed experts and require commercial funding to cover page costs. These documents do not require prior approval of the STS, but are peer reviewed. The format of the article or articles is that of a review article. Word limits are negotiable.

Reviews originate with authors and are peer reviewed. The total word limit is 6500 words and the number of references should not exceed 80. The structured abstract is limited to 250 words, which are included in the word count. Reviews must have a Methods section that describes the sources (databases, prior publications, etc.) that were searched. Topics should be reasonably broad (as opposed to rare diseases) and preferably ones about which there is doubt or controversy regarding management. Authors should seek to integrate data learned from the review and not merely provide one line précis of prior publications.

Meta-analyses and Systematic Reviews are required to be cleared via a proposal and completion of the Meta-Analysis and Systematic Review Pre-Submission Form. Please submit your form and proposal to, and you will receive an answer within 7-10 days either declining or confirming an invitation to submit. Approved requests are guaranteed external review but not acceptance of your manuscript. Meta-analyses/systematic reviews that are submitted and did not receive pre-submission clearance will be returned to you without review. Meta-analysis and systematic reviews should conform to PRISMA guidelines for transparent reporting (, and a completed PRISMA Checklist and PRISMA Flow Diagram should be included as attachments along with your pre-submission form. A systematic review answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria and uses a clearly defined search strategy. A meta-analysis is the use of statistical methods to summarize the results of these published studies.

Invited Expert Reviews are solicited at the Editor's discretion.

Surgical Heritage articles are limited to 4500 words and describe breakthrough achievements that created and directly led to new surgical therapy for thoracic diseases. These articles may or may not include biographical précis of the architects of the achievement. The category is designed to interest our entire readership and therefore does not include tributes, anecdotes of isolated procedures which were not further developed, or vignettes of interesting history or discovery. Memorials are usually limited to past presidents of the STS and are published as Surgical Heritage articles. Memorials are limited to 2500 words and two photographs. Authors are chosen by the STS Board of Directors. Authors are asked to include contributions to the STS of the deceased during his or her ascent to office as well as achievements during and after leaving the presidency.

Correspondence (Letters to the Editor) and commentaries are limited to 500 words. Do not include tables and subtract 100 words for each illustration.

Table A


Table B


5. Order of Content Within Manuscripts (Items in order from front to back; pages must be numbered; double spacing is required)

  • Title Page (first page)

  • Title. The title is limited to 100 characters and spaces for original articles and up to 80 characters and spaces for all other categories of manuscripts. The title may not contain acronyms or abbreviations. All submissions must have a title.

    Running Head. Supply a short title of 40 characters or fewer (including spaces).

    Authors. List all authors by first name, all initials, family name, and highest earned academic degree (eg, MD) or degrees (eg, MD, PhD). The Annals adheres to ICMJE guidelines for attibuting authorship.

    Institutions and Affiliations. List the name and full address of all institutions in which the described work was done. List departmental affiliations of each author after each institutional address. Connect authors to departments using numbered superscripts.

    Meeting Presentation. If the paper has been or is to be presented at the annual meeting of The Society of Thoracic Surgeons or the Southern Thoracic Surgical Association, or any other meeting, provide the name, location, and dates of the meeting.

    Classifications. Select up to 5 classifications from the list provided as part of the online submission process.

    Word Count. Provide the total word count of the entire manuscript including title page, abstract, text, acknowledgments, disclosures, tables, figure legends, and entire reference list. Do not omit any words or number sequences in the word count that will appear in the published document.

    Corresponding Author. Provide the name, exact postal address with zip or postal code, telephone number, fax number and email address of the author to whom communications should be sent after publication. The corresponding author must have a graduate degree; accept responsibility for the integrity of the submitted work; and attest that no undisclosed authors contributed to the manuscript.

  • Abstract, Graphical/Visual Abstract (second page)

  • Original and Review articles. Provide a structured abstract, no longer than 250 words, divided into four sections: Background, Methods, Results, and Conclusions. These subject headings are not part of the following sentence, which must be a complete sentence. Avoid abbreviations and acronyms. Indicate the abstract word count below the abstract. In addition, authors are encouraged, but not required, to submit a Graphical/Visual abstract. A Graphical (or Visual) Abstract is a single, concise, pictorial and visual summary of the main findings of the article. This could be a figure that is specially designed for this purpose, which captures the content of the article for readers at a single glance. These are displayed in online search results, as well as with the online article and its content page. For more information on how to create a Graphical Abstract, please see:

  • Text (third page, after title page and abstract and continuing up to "Acknowledgments")

  • Text should be organized as follows: Introduction, Patients and Methods (or Material and Methods), Results, and Comment.

    Cite references, illustrations, and tables in the order in which they are mentioned in the text.

    Abbreviations. Consult the American Medical Association Manual of Style, 10th edition, for recommended abbreviations. Define abbreviations at first appearance in the text. If 8 or more abbreviations or acronyms are used, provide a separate table of abbreviations and acronyms.

    Measurements and weights should be given in standard metric units.

    Follow the "Guidelines for Data Reporting and Nomenclature" published in The Annals of Thoracic Surgery (1988;46:260.1) for guidance on statistical nomenclature and data analysis. Statistical models and formulas used in the analysis of data should be stated in the last paragraph(s) of "Patients and Methods."

    Footnotes. Type footnotes at the bottom of the manuscript page on which they are cited.

    Suppliers. Credit suppliers of drugs, equipment, and other commercial material mentioned in the article within parentheses in text by providing the company name, city and state (or city and country if outside the United States).

  • Acknowledgments and Disclosures

  • Grants, financial support, and technical or other assistance are acknowledged at the end of the text before the references. All financial support for the project must be acknowledged and will be printed in the article. Conflict of interest disclosures are indicated on the Conditions for Publication Form, which must be completed by all authors. This information will appear in a conflict box at the bottom of the first published page of the article.

    A disclosure statement is required for all studies that received financial, property, or intellectual aid from a commercial source for all categories of articles published in The Annals. The disclosure statement must state the source(s) of all funds used to support the study or to perform an evaluation and whether or not property or tested technology was purchased, borrowed, or donated to the study. In addition, the authors will confirm in the submission process that they had freedom of investigation and full control of the design of the study, methods used, outcome parameters and results, analysis of data, and production of the written report. These agreements are mandatory for all articles, and conflicts of interest disclosures are published with the article. (See the Conditions for Publication Form for definitions of financial support and freedom of investigation. Note that any undisclosed authors would need to be identified during the submission process.

  • References

  • Identify references in the text in consecutive numeric order by means of superscript Arabic (1-3, etc) numerals (comma between numbers; use a hyphen for a series of 3 or more). Do not cite personal communications, manuscripts in preparation, or other unpublished data as references.

    Type references double-spaced after text or acknowledgments beginning on a separate sheet. Number consecutively in the order in which they appear in the text. The references must not be linked to the manuscript with EndNotes because that formatting is not compatible with automated publication production processes.

    Journal references should provide inclusive page numbers; book references should cite specific page numbers.

    Authors are solely responsible for accuracy, completeness, and nonduplication of references and for the correct spelling of names of all authors.

    Journal abbreviations should conform to those used in PubMed. The style and punctuation of the references should follow AMA (please see the formats outlined in the examples below):

    Journal Article
    Miller CB, Rowlings PA, Zhang MJ, et al. The effect of graft purging with 4-hydroperoxycyclophosphamide in autologous bone marrow transplantation for acute myelogenous leukemia. Exp Hematol. 2001;29:1336-1346.
    (List all authors if 6 or fewer; otherwise list first 3 and add "et al.")

    Chapter in Book
    Gross SS, Aisaka K, Jaffe EA, et al. Nitric oxide synthesis. In: Levi R, Griffith OW, eds. Biochemistry Basics. New York, NY: Biopub Inc.; 1990:131-158.

    Health Care Financing Administration. 1996 statistics at a glance. Available at: Accessed December 2, 1996.

  • Tables

  • For best results, Tables should be created using the Table tool in a Word document. Limit one table per page. Each table should be numbered (Arabic) and have a title above. Legends and explanatory notes should be placed below the table. Abbreviations used in the table follow the legend in alphabetic order. Lower case letter superscripts beginning with "a" and following in alphabetic order are used for notations regarding statistics. For P values less than .001, report as "P < .001"; for P values between .001 and .01, report the value to the nearest thousandth; for P values greater than or equal to .01, report the value to the nearest hundredth; and for P values greater than .99, report as "P > .99." Do not list NS ("not significant") for any values. Tables should be self-explanatory, and tabulated data should not be duplicated in the text or illustrations. Tables must be submitted as part of the text file and not as illustrations.

  • Figure Legends

  • Figure legends should be numbered (Arabic) and typed double-spaced in order of appearance beginning on a separate sheet. Identify (in alphabetical order) all abbreviations appearing in the illustrations at the end of each legend. Give the type of stain and magnification power for all photomicrographs.

  • Illustrations

  • Images or figures are submitted as one or more separate files that may contain no more than four images per file. Within each file containing images, use the figure number (eg, Figure 1A) as the image filename. The system accepts image files formatted in TIFF and EPS. Line art (black and white or color) and combinations of gray scale images and line art should be at least 1000 DPI. Line art, such as Kaplan-Meier curves, also includes any bar graphs, line graphs, scatter plots, etc. Color images and gray scale halftones must be at least 300 DPI. For further information on figure preparation, please see Symbols should be of a similar size. Images should be tightly cropped. Please obtain technical help if you are unfamiliar with image files. The Annals editorial staff is available during business hours 9am-5pm, Central time U.S., Monday through Friday, to help answer questions.

    Illustrations may not be separately copyrighted or have a copyright logo. Illustrations may have a discrete signature of the artist if permitted by the payer of the illustrative work. As a condition for publication, copyright for all art is ceded to The Society of Thoracic Surgeons.

    Symbols, letters, numbers and contrasting fills must be distinct, easily distinguished, and clearly legible when the illustration is reduced in size. Most illustrations will be reproduced at a width of one column (8.25 cm; 3-1/4 inches). The lettering on artwork should be no smaller than 10 point font for normal text. Smaller lettering will not be legible. Black, white, and widely crosshatched bars are preferable; do not use stippling, gray fill, or thin lines.

    Written permission for publication from any patients (masked or unmasked) appearing in photographs must be obtained by the authors and must be emailed ( or faxed (312-268-5263) once the manuscript is submitted.

    Color illustrations. Color illustrations do not incur a color surcharge and are usually preferable over black and white illustrations. All photomicrographs must be submitted in color.

    Original illustrations. If your manuscript is accepted for publication and the art you have submitted online is not acceptable for reproduction purposes, staff may notify you to send a set of original illustrations. These illustrations will not be returned.

  • Supplemental Material

  • Supplemental material (including any supplemental tables, text, figures, or videos) should be uploaded by authors during the submission process.

    --For any supplemental tables, text, and figures, authors should select the "Supplemental/Appendix material" file type at submission.

    --For videos only, authors should select the "Supplemental Video" file type.

    Please note: The maximum file size for any peer-reviewed video is 75MB. You will need to reduce your file size if it is over this limit. Authors will be required to comply with requests to remove material if it is deemed excessive.

6. Protection of Human and Animal Subjects

Human Investigation

Institutional Review Board (IRB), Ethics Committee (EC), or a comparable group must approve all articles that contain information about human subjects. The local IRB also decides whether or not patient consent is required or waived. The IRB or EC, not the author, makes review decisions for every study involving human subjects or information about human subjects. The investigator should retain, but not submit the decision letter granting IRB approval. Study approval and patient consent or waiver of the need for consent must be stated in the first paragraph under the Patients and Methods section. Authors will also confirm this approval, if applicable, during the submission process.

Humane Animal Care

When animals are used as subjects, institutional approval of the protocol is necessary and authors should include a statement in the Methods indicating that investigators complied with the 2011 "Guide for the Care and Use of Laboratory Animals" (, recommended by the U.S. National Institutes of Health, or with equivalent guidelines administered by the author's governmental regulatory body. When no formal ethics review process is available, authors must state that humane care was provided in animal experiments, in accordance with either of the above guidelines.

7. Conditions for Publication Form

The Society of Thoracic Surgeons and The Annals require all authors to adhere to the highest ethical standards of our profession. Ethical breaches include scientific misconduct (falsification or fabrication), plagiarism, and redundant publication and are described more fully in Ann Thorac Surg. 1999;68:1, Ann Thorac Surg. 2007;84:717-719, Ann Thorac Surg. 2012;93:9-10, and Ann Thorac Surg. 2015;100:784.

The Annals follows the Committee on Publication Ethics (COPE) Guidelines for issues of fraud, image manipulation, and duplicate publication. Briefly, the Editor will consider retracting a publication if:

  • there is clear evidence that the findings are unreliable, either as a result of misconduct (eg, data fabrication) or honest error (eg, miscalculation or experimental error)

  • the findings have previously been published elsewhere without proper crossreferencing, permission or justification (ie, cases of redundant publication)

  • it constitutes plagiarism

  • it reports unethical research

More information on the COPE Retraction Guidelines can be found at

Before publication of an accepted manuscript each author is required to certify by signing the Conditions for Publication Form that he or she has participated sufficiently in the work to take responsibility for a meaningful share of the content of the manuscript, according to International Committee of Medical Journal Editors (ICMJE) criteria stated on the form. In addition to ICMJE authorship criteria, the Conditions for Publication Form covers conflicts of interest, freedom of investigation, exclusive publication, and copyright transfer.

Elsevier supports responsible sharing. Find out how you can share your research published in Elsevier journals.

8. Permissions

Written permission must be obtained from the appropriate copyright holder to reproduce previously published or copyrighted material in The Annals. The original source of the material must be properly cited in the accompanying figure/table legend. The corresponding author is responsible for providing written permission, which must be sent to The Annals upon manuscript submission via email ( or fax (312-268-5263).

You can obtain permission to reproduce Annals content from ScienceDirect by following these steps:

  • Search for the material you wish to use on

  • Click on the "get rights and content" link on the article's landing page.

  • You will then be redirected to the Copyright Clearance Center RightsLink page where you will follow the prompts to request permission.

  • Once your permission request is approved, send the Elsevier License Terms and Conditions to The Annals via email ( or fax (312-268-5263).

9. Miscellaneous

NIH Initiative

The United States National Institutes of Health (NIH) requires that all investigators funded by the NIH submit or have submitted for them an electronic version of their final, peer-reviewed manuscripts upon acceptance for publication. The electronic manuscript is sent to the National Library of Medicine's PubMed Central (PMC) (, where it is made publicly available no later than 12 months after the official date of publication (

If your article is ultimately accepted, Elsevier will submit the electronic version of the final, peer-reviewed manuscript to PMC on behalf of the authors. For this process to take place, however, the corresponding author should disclose NIH funding on the Elsevier Rights and Access form, which will be sent to authors upon manuscript transmittal. The following process takes place after authors indicate on this form that their article is NIH-funded:

  • Manuscript is released to PMC.

  • PMC generates their own PDF file and sends to the Author to approve.

  • NIHMS ID # allocated.

  • Once the Corresponding Author approves the PDF file generated by PMC/NIH helpdesk, a PMC ID # will then be allocated to the manuscript.

Randomized Controlled Trials

The Annals follows the ICMJE recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals by both endorsing the CONSORT Statement regarding randomized controlled trials ( and supporting mandatory registration of all publicly or commercially funded clinical trials as a condition for publication. The Annals also recommends that investigators who plan to publish their clinical trial work review the CONSORT E-Flowchart and Checklist (available at before enrollment of subjects begins. Authors are also encouraged to submit their CONSORT checklist and diagram at the time of submission, leaving blank the page number of any item that wasn't done as part of the study; no study is expected to have addressed all the items on the checklist. These documents are intended to be used for review purposes only, and will not be published. Authors will see a ?CONSORT checklist/diagram? file type during the submission process.

Randomized controlled trials should be free of bias and of misleading information due to, for example, insufficient numbers of subjects and failure to define primary and secondary endpoints. The Checklist succinctly and comprehensively defines the attributes of a well-designed and reported randomized controlled trial.

Registration of Clinical Trials

The Annals supports mandatory registration of all publicly or commercially funded clinical trials, including Phase I and II trials, as a condition for publication. Information regarding requirements for registration of a clinical trial may be found at Information for registering a clinical trial is available at The trial registration number should appear at the end of the abstract. Authors will be prompted to confirm the registration number during the submission process.

Post-Acceptance Changes in Authorship

Once a manuscript is accepted for publication, a) authors cannot be removed from or added to the author list, and b) the order of the authors cannot be changed without written permission (email confirmation, PDF signatures okay) from each of the co-authors and approval by the editorial staff.

Archiving Policy for Submissions in Online Manuscript Tracking System

Any manuscript, unpublished or published, will be removed from the system after 12 months.

Required information to be emailed ( or faxed (312-268-5263) to The Annals staff:

  • The Conditions for Publication Form signed by all authors with appropriate boxes checked.

  • Written permission from the publisher to reproduce previously published illustrations or tables, if applicable.

  • Written permission from any patients (masked or unmasked) appearing in photographs, if applicable.

Updated April 12, 2021