Ulrik Sartipy

• MD PhD
• Consultant at Karolinska University Hospital

Aims: The objective was to investigate the long-term all-cause mortality in patients aged 50-69 years after aortic valve replacement (AVR) with bioprosthetic or mechanical valves. Methods and results: All patients aged 50-69 years who had undergone AVR in Sweden 1997-2013 were identified from the Swedish Web-system for Enhancement and Developmen...

Background: Contemporary data on loss in life expectancy after aortic valve replacement (AVR) are scarce, particularly in younger patients. Objectives: The purpose of this national, observational cohort study was to analyze long-term relative survival and estimated loss in life expectancy after AVR. Methods: The study included 23,528 patients...

Importance: The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. Objective: To analyze the long-term rat...

Background Whether low socioeconomic status (SES) is associated with increased risk of anticoagulation-related adverse events in patients with mechanical heart valves is unknown. Objectives This study sought to investigate the impact of patients’ SES on the risk of bleeding after mechanical aortic valve replacement (AVR). Methods This nationwide...

Background: Prosthesis-patient mismatch (PPM) is common following surgical aortic valve replacement (SAVR). Objectives: The purpose of this study was to quantify the impact of PPM on all-cause mortality, heart failure hospitalization, and reintervention following bioprosthetic SAVR. Methods: This observational nationwide cohort study from SWED...

In patients requiring heart valve replacement for valve disease, several factors should be considered when choosing the type of prosthetic heart valve. Current guidelines do not mention the future risk of prosthetic valve endocarditis as a factor to consider when choosing the prosthesis. Prosthetic valve endocarditis occurs at rates similar to thos...

Background: Cardiac surgery is a significant procedure that reduces mortality and alleviates symptom burden in individuals with cardiovascular diseases. However, many patients develop depression and cardiac-related anxiety postoperatively, which negatively affects long-term prognosis and rehabilitation. There is a clinical need to develop scalable...

Background Permanent pacemaker implantation is associated with an increased risk of mortality and heart failure after surgical aortic valve replacement (SAVR). Objectives The purpose of this study was to analyze long-term prognosis of permanent pacemaker implantation following SAVR on low-risk patients. Methods This nationwide, population-based,...

Background Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting. Methods This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in...

Background The internal thoracic artery (ITA) is the most important conduit for coronary artery bypass grafting. Recent evidence suggests that skeletonized ITA harvesting yields long‐term outcomes inferior to those of pedicled harvesting. The aim was to investigate the impact of the ITA harvesting method on 10‐year mortality and major adverse cardi...

Background and Aims Transcatheter aortic valve implantation (TAVI) has become the first choice to treat older patients with severe symptomatic aortic stenosis (AS). This study aimed to compare TAVI with surgery in low-risk patients ≤ 75 years of age, including both tricuspid and bicuspid AS. Methods The NOTION-2 trial enrolled and 1:1 randomized l...

Background We hypothesised that a continuous 72-h bilateral parasternal infusion of lidocaine at 2×35 mg h⁻¹ would decrease pain and the inflammatory response after sternotomy for open heart surgery, subsequently improving quality of recovery. Methods We randomly allocated 45 participants to a 72-h bilateral parasternal infusion of lidocaine or sa...

Importance Aggregated data and long-term follow-up in national health data registers offer the opportunity to compare the performance of mechanical aortic prostheses within the same population. Objective To investigate the clinical performance of mechanical aortic valve prostheses. Design, Setting, and Participants This nationwide cohort study in...

OBJECTIVES To assess the feasibility and safety of uniportal video-assisted thoracoscopic pulmonary segmentectomy compared with lobectomy by studying early postoperative outcomes. METHODS We included all patients who underwent uniportal segmentectomy and lobectomy between 2017 and 2022 at Karolinska University Hospital. Early clinical outcomes wer...

OBJECTIVES Depression has been associated with increased cardiovascular morbidity and mortality. This study aimed to determine whether self-reported preoperative depressive symptoms were associated with worse long-term survival in patients undergoing cardiac surgery. METHODS This population-based, observational cohort study included patients who h...

Background Whether a bovine or porcine aortic valve bioprosthesis carries a higher risk of endocarditis after aortic valve replacement is unknown. The aim of this study was to compare the risk of prosthetic endocarditis in patients undergoing aortic valve replacement with a bovine versus porcine bioprosthesis. Methods and Results This nationwide,...

Background Surgery for infective endocarditis (IE) is associated with a high risk of receiving a new permanent pacemaker. The clinical impact of permanent pacemaker implantation in these patients is unknown. Research question Does permanent pacemaker implantation after aortic valve surgery for IE affect long-term clinical outcomes? Aims To analyze...

Background: Peripheral blocks are increasingly used for analgesia after video-assisted thoracic surgery (VATS). We hypothesised that addition of sufentanil and adrenaline to levobupivacaine would improve the analgesic effect of a continuous extrapleural block. Methods: We randomised 60 patients undergoing VATS to a 5-mL h-1 extrapleural infusion...

Background Evidence is mixed regarding the most appropriate type of valve prosthesis for surgical aortic valve replacement (AVR) in patients 50 to 69 years. American and European guidelines differ. Objectives The purpose of this study was to determine the long-term all-cause mortality and complication rates after AVR in patients aged 50 to 69 year...

Little is known about long-term quality of life (QOL) and functional status after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We investigated QOL and functional status late after PEA. All patients who underwent PEA for CTEPH 1993-2020 at one Swedish center were included. Baseline characteristics and dat...

The TACSI trial (ClinicalTrials.gov Identifier: NCT03560310) tests the hypothesis that one-year treatment with dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and ticagrelor is superior to only ASA after isolated coronary artery bypass grafting (CABG) in patients with acute coronary syndrome. The TACSI trial is an investor-initiate...

Background Bleeding following lung surgery can lead to reoperation and blood transfusions, potentially impairing outcomes. This study aimed to assess how bleeding complications affect long-term survival and postoperative complications in a nationwide contemporary group of patients undergoing lung resections. Methods Adult patients who underwent lu...

Background: The objective of this study is to investigate clinical outcomes in patients with bicuspid aortic valves (BAV) after surgical treatment for endocarditis. Methods: This was a population-based, observational cohort study, conducted on all patients who received aortic valve surgery for native or prosthetic valve endocarditis at Karolinsk...

Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non‐cardiac re...

Background Multimodal analgesia that provides optimal pain treatment with minimal side effects is important for optimal recovery after open cardiac surgery. Regional anaesthesia can be used to block noxious nerve signals. Because sternotomy causes considerable pain that lasts several days, a continuous nerve block is advantageous. Previous studies...

This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with long‐term survival. All patients who underwent PEA for CTEPH at two Scan...

Objectives Women have a worse prognosis after coronary artery bypass grafting (CABG) surgery compared to men. We sought to quantify to what extent this difference in post-CABG survival could be attributed to sex itself, or whether this was mediated by difference between men and women at the time of intervention. Additionally, we explored to what ex...

Aims: A diagnosis of depression in patients with coronary heart disease is associated with worse outcomes. This study examined the long-term risk for new onset of depression after coronary artery bypass grafting (CABG) compared to an age- and sex-matched control group from the general population. Methods and results: In total, 125 418 primary is...

Background Prior studies showed that life expectancy in patients who underwent surgical aortic valve replacement (AVR) was lower than in the general population. Explanations for this shorter life expectancy are unknown. The aim of this nationwide, observational cohort study was to investigate the cause‐specific death following surgical AVR. Method...

Objective Bioprosthetic aortic valves with an extended subannular component, such as transcatheter valves, exert increased compression on the cardiac conduction system and increase the risk for permanent pacemaker implantation. It is unknown if the On-X mechanical prosthetic valve, which has an elongated subannular valve housing, increases the risk...

Objective To assess sex differences in short- and long-term mortality in patients who develop acute kidney injury after coronary artery bypass grafting. Design Observational cohort study. Setting Multi-center, nationwide, population-based observational cohort study. Participants All patients (n =32013) who underwent primary non-emergent isolated...

Background: We performed a nationwide population-based cohort study to investigate sex differences in rate of permanent pacemaker implantation after surgical aortic valve replacement (AVR). Methods: This study included all adult patients who underwent primary AVR in Sweden between 2005 and 2018. Study data were obtained from the SWEDEHEART regis...

b>Background Studies have suggested sex−related survival differences in chronic thromboembolic pulmonary hypertension (CTEPH). Whether long−term prognosis differs between men and women following pulmonary endarterectomy (PEA) for CTEPH remains unclear. We investigated sex−specific survival after PEA for CTEPH. Methods We included all patien...

Importance Prior studies investigating the long-term clinical outcomes of patients who have undergone permanent pacemaker implantation after aortic valve replacement reported conflicting results. Objective To investigate long-term outcomes after primary surgical aortic valve replacement among patients who underwent postoperative permanent pacemake...

Objectives Our objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified by indication, who received a Freestyle® bioprosthesis as a full aortic root replacement. Methods Data from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle® bioprosthe...

Background No guideline-directed pharmacological therapy has been established for patients with myocardial injury without type 1 myocardial infarction. We investigated the impact of statin treatment in patients with myocardial injury. Methods Patients with myocardial injury (non-ischemic acute and chronic myocardial injury), type 2 myocardial infa...

Objectives The objective of this cohort study was to analyse long-term relative survival in patients with bicuspid aortic valve (BAV) who underwent aortic valve surgery. Methods We studied 865 patients with BAVs who participated in three prospective cohort studies of elective, open-heart, aortic valve surgery at the Karolinska University Hospital,...

Background There is no clinical guidance on treatment in patients with non‐ischemic myocardial injury and type 2 myocardial infarction (T2MI). Methods and Results In a cohort of 22 589 patients in the emergency department at Karolinska University Hospital in Sweden during 2011 to 2014 we identified 3853 patients who were categorized into either ty...

Background Prior reports on a possible female survival advantage in both surgical and non-surgical cohorts of patients with lung cancer are conflicting. Previously reported differences in survival following lung cancer surgery could be due to insufficient control for disparities in risk factor profile in men and women. Research Question Do women w...

Chronic thromboembolic pulmonary hypertension is a subtype of pulmonary hypertension that affects 0,5-4% of patients who have had a pulmonary embolism. Emboli in the pulmonary arteries lead to fibrosis, obstruction and remodeling of the pulmonary arteries which causes increased pulmonary arterial blood pressure and increased pulmonary vascular resi...

Background Few studies have analyzed outcomes after surgery for endocarditis in intravenous drug users (IVDUs). The aim of this study was to compare survival after surgery for endocarditis in IVDUs versus non-IVDUs. Secondary outcomes were rate of reoperation, re-infection, and relapse to drug use. Methods This population-based, observational coho...

Background Previous studies have reported superior hemodynamic performance with bovine bioprosthetic aortic valves compared with porcine valves. However, conflicting results mean the long-term effect on survival is not well known. The aim of this study was to examine long-term survival, rate of aortic valve reoperations, and heart failure hospitali...

Introduction Socioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should be unrelated to household income. The aim of this study was to investigate the association between household dispos...

Background Disturbances of glucose metabolism are important risk factors for coronary artery disease and are associated with an increased mortality risk. The aim was to investigate the association between preoperative disturbances of glucose metabolism and long-term all-cause mortality after coronary artery bypass grafting (CABG). Methods Patients...

Pulmonary endarterectomy is the guideline recommended treatment for chronic thromboembolic pulmonary hypertension, in addition to life-long anticoagulation therapy. The aim was to analyze long-term relative survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. We included all patients who underwent pulmonary end...

[This corrects the article DOI: 10.21037/jtd.2018.05.177.].

Background Comorbidities may differently affect treatment response and cause-specific outcomes in heart failure (HF) with preserved (HFpEF) vs. mid-range/mildly-reduced (HFmrEF) vs. reduced (HFrEF) ejection fraction (EF), complicating trial design. In patients with HF, we performed a comprehensive analysis of type 2 diabetes (T2DM), atrial fibrilla...

The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVG) harvested with the “No-touch” (NT) technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique (COS). This paper describes the rationale and design of the randomized trial...

Background A systematic review of low-risk death has been shown successful in identifying system weaknesses. The aim was to analyse early mortality in low-risk patients undergoing cardiac surgery and to determine the cause of death, classify if they were unavoidable or potentially preventable as a result of technical or system errors. Methods We i...

Background: Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs). Objective: The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality. Methods: Heart...

Background: Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer pat...

Background: Many patients presenting with chest pain in the emergency department have stable concentrations of high-sensitivity cardiac troponin T (hs-cTnT) without any acute medical condition. Stable hs-cTnT levels are associated with a high risk of death. This study aimed to investigate causes of death in relation to hs-cTnT concentrations. Met...

Background: Information about causes of death in patients with myocardial injury is limited. The purpose of this study was to explore causes of death in patients with myocardial injury. Methods: In a cohort of 22,589 patients, 3,853 patients with myocardial injury were identified and categorized into: type 1 myocardial infarction, type 2 myocard...

Background Information about causes of death in patients with non-ischemic acute and chronic myocardial injury is limited. Purpose To explore causes of death, mortality rates and risks of cardiovascular and non-cardiovascular causes of death in patients with type 1 MI (T1MI), type 2 MI (T2MI), and acute and chronic myocardial injury compared with...

Background/Introduction Persistently elevated high-sensitivity cardiac troponin T (hs-cTnT) levels above the 99th percentile value indicate ongoing chronic myocardial injury which is associated with a high risk of death, heart failure, and myocardial infarction. No prior studies have thoroughly investigated the causes of death in patients with chro...

Background Prior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile. Methods and Results In a population‐based cohort study, we included all adults ≤50 years of age (932 women and 4514 men...

Objective Blood type A antigen on porcine aortic bioprostheses might initiate an immune reaction leading to an increased frequency of structural valve deterioration in patients with blood type B or O. The aim was to analyse the association between ABO blood type and porcine bioprosthetic aortic valve degeneration. Design Observational nationwide c...

Background: The aim was to investigate longitudinal changes in depression screening results by sex up to one year following cardiac surgery. Methods: We introduced a depression screening project using the Patient Health Questionnaire (PHQ-9) including patients between 2013-2016. Patients received the PHQ-9 prior to surgery, and at follow-up one...

Aims To assess the association between atrial fibrillation (AF) and mortality, and also the association between resting heart rate (HR) and mortality in both sinus rhythm (SR) and AF in patients with heart failure with preserved ejection fraction (HFpEF). Methods and results A total of 9090 patients with HFpEF (ejection fraction ≥ 50%) were includ...

Background: Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a co...

Data include pain scores at postoperative days (POD) 0-3 at rest and with movement, alongside basic demographic information.

The prognosis in patients with chest pain and chronic myocardial injury compared with patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unknown. This study aims to investigate differences in long-term outcomes. Patients with chest pain at Karolinska University Hospital, Sweden from 2011 to 2014, who had stable high-sensitivit...

Background: We studied the association between heart failure with reduced or preserved ejection fraction (EF) and the risk of acute kidney injury (AKI) in patients undergoing coronary artery bypass surgery (CABG). Methods: We included all patients who underwent isolated CABG in Sweden 2003 to 2013. AKI was defined according to the Kidney Disease Im...

Objective Minimally invasive aortic valve replacementsurgery (MIAVR) is an alternative surgical technique to conventional aortic valve replacement surgery (AVR) in selected patients. The randomised study Cardiac Function after Minimally Invasive Aortic Valve Implantation (CMILE) showed that right ventricular (RV) longitudinal function was reduced a...

Background: This study aimed to describe overall survival following pulmonary metastasectomy for colorectal cancer (CRC) in Sweden, and to assess the discrimination of a recently proposed risk prediction model. Methods: Individual-level data of 756 patients who underwent resection of pulmonary metastases from CRC between 2009 and 2015 were obtai...

Background: The aim of this nationwide observational cohort study was to investigate the early postoperative complications and long-term survival following video-assisted thoracoscopic surgery (VATS) lobectomy compared to open thoracotomy lobectomy for early stage non-small cell lung cancer (NSCLC). Methods: We used the Swedish national quality...

Background Bovine and porcine bioprostheses are commonly used for surgical aortic valve replacement. It is unknown if the long-term survival differs between the two valve types. We performed a systematic review and meta-analysis to compare survival in patients who underwent aortic valve replacement and received a bovine or a porcine prosthesis. Met...

Background: Depression is common in patients with ischaemic heart disease and preoperative depression is a risk factor following coronary artery bypass grafting. The American Heart Association recommends depression screening in all patients with heart disease. Our aim was to assess the feasibility and results of a depression screening program in c...

Objectives: Our goal was to validate the Swedish Cardiac Surgery Registry by reviewing the reported cardiac operations to assess the completeness and quality of the registered data and the EuroSCORE II variables. Methods: A total of 5837 cardiac operations were reported to the Swedish Cardiac Surgery Registry in Sweden during 2015. A randomly se...

Objective Atrial fibrillation (AF) is common in patients with heart failure (HF), and oral anticoagulants (OAC) are indicated. The aim was to assess prevalence of, predictors of and consequences of OAC non-use. Methods We included patients with AF, HF and no previous valve replacement from the Swedish Heart Failure Registry. High and low CHA2DS2-V...

Purpose of review: Several advances have been made in recent years to improve outcome for patients with coronary artery disease. One of the most debated topics regarding surgical treatment with coronary artery bypass grafting (CABG) is graft selection. This review aims to present the current status and scientific evidence for bilateral internal th...

Objectives: Right ventricular (RV) function is impaired after cardiac surgery, possibly because of the opening of the pericardium. In minimally invasive aortic valve replacement, the pericardium is only partially incised. Methods: A randomized trial compared RV function after ministernotomy versus full sternotomy in 40 adults undergoing aortic v...

Background: Evidence for pulmonary metastasectomy following colorectal cancer (CRC) is scarce. The aim of the study was to investigate long-term survival and identify prognostic factors to aid patient selection. Methods: We included all patients who underwent pulmonary resections for CRC metastases between January 01, 2004 and December 31, 2015...

Aims: This study aimed to investigate the association between insulin resistance as determined by the estimated glucose disposal rate (eGDR), and survival in adults with type 1 diabetes (T1D) in Sweden. Material and methods: Using the Swedish National Diabetes Register, people with T1D were included from January 1, 2005 to December 31, 2012. Out...

Background The prevalence of hypo‐attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) is unknown in surgically implanted bioprostheses because systematic investigation of HALT and/or RLM is limited to a few catheter‐based valves. The aim of this study was to investigate the prevalence of HALT and RLM by cardiac computed tomography...

Data S1. Supplemental methods. Table S1. Prosthesis Size Figure S1. Perceval sutureless aortic valve bioprosthesis (LivaNova, Milan, Italy). Figure S2. Cardiac computed tomography multiplanar reformatted reconstructions of a Perceval sutureless aortic valve bioprosthesis in middiastole. The noncoronary cusp (A) was normal, with no signs of hypo‐...