Increased Risk of Transmission of Hepatitis C in Open Heart Surgery Compared With Vascular and Pulmonary Surgery Karina Olsen, MD, Per Erling Dahl, MD,

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Increased Risk of Transmission of Hepatitis C in Open Heart Surgery Compared With Vascular and Pulmonary Surgery Karina Olsen, MD, Per Erling Dahl, MD, PhD, Eyvind J. Paulssen, MD, PhD, Anne Husebekk, MD, PhD, Anders Widell, MD, PhD, Rolf Busund, MD, PhD The Annals of Thoracic Surgery Volume 90, Issue 5, Pages 1425-1431 (November 2010) DOI: 10.1016/j.athoracsur.2010.06.053 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Time-line for the look-back procedure. (A) Events leading to initiation of the look-back process from the surgeon testing positive for hepatitis C in February 2007 to the completion of the process in April 2008. (B) The initial look-back period and the 4-month extension. Hepatitis C positive patients are numbered sequentially after date of surgery (numbers correspond to Table 1). (HCV = hepatitis C virus; Capital letters = name of months.) The Annals of Thoracic Surgery 2010 90, 1425-1431DOI: (10.1016/j.athoracsur.2010.06.053) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Genetic relatedness among outbreak hepatitis C virus (HCV) strains and clinically unrelated controls from the same county. Sequences from HCV polymerase chain reaction (PCR) positive samples, all genotype 1a, were compared in order to calculate their relative genetic distances (p-distances). The p-distance or genetic difference between any two sequences is obtained by adding the length of all horizontal tree segments linking the two and relating the added length to the included size bar (where 0.02 corresponds to 2%). Analysis was done separately for two different HCV genes; the moderately genetically conserved HCV polymerase NS5B region (A) and the highly variable N-terminal region of the larger HCV envelope protein E2 (B). Sequences from the surgeon, his implicated patients (patient nos. 2 to 13), and the unrelated HCV genotype 1a controls (capital letters) are labeled accordingly, and two GenBank genotype 1a sequences are included for reference (Ref 1a and 1b). The Annals of Thoracic Surgery 2010 90, 1425-1431DOI: (10.1016/j.athoracsur.2010.06.053) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schematic overview of the patients involved in the study. The Annals of Thoracic Surgery 2010 90, 1425-1431DOI: (10.1016/j.athoracsur.2010.06.053) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions