Information for open-heart surgery patients

SA Government | Health Communicable diseases fact sheet

This advice is provided for patients in SA who have had open-heart surgery and who may be concerned about reports of a risk of infection with Mycobacterium chimaera during surgery as a result of contamination of some heater-cooler units. It is important to remember that the benefits of surgery outweigh the very small risk of infection associated with these devices. Should you have any concerns or queries please contact your General Practitioner (GP) or Cardiac Surgeon.

Mycobacterium chimaera in heater-cooler devices
Frequently Asked Questions

What is the issue?

There is a risk that some heater-cooler devices used in cardiac surgery may have been contaminated with a rare environmental bacterium called Mycobacterium chimaera (M. chimaera), and that exposure of patients to aerosols from these devices may lead to infections that can appear months to years after surgery.

Infection of cardiac surgery patients with M. chimaera associated with a particular heater-cooler device type (made by LivaNova [formerly Sorin] in Germany) was first recognised several years ago in Switzerland. These devices, which are widely used around the world, including Australia, are thought to have been contaminated during the manufacturing process in Europe.

At least 70 patients worldwide have been identified with M. chimaera infections after cardiac surgery. So far, only one patient has been reported in Australia (from Queensland) with M. chimaera infection that has been linked to exposure to a heater-cooler device. We are not aware of any patients in South Australia who have developed this infection to date.

What is Mycobacterium chimaera?

M. chimaera is one of a group of bacteria known as non-tuberculous Mycobacteria (NTM) which are commonly found in the environment, including soil and water. NTM typically are not harmful; however in very rare cases they can cause infections in post-operative surgical patients. M. chimaera bacteria are slow-growing and it may take several months to over a year for an infection to develop.

What are heater-cooler devices?

Heater-cooler devices are used during open heart surgery to warm or cool a patient’s blood during the procedure. It has recently been recognised that there is the potential for M. chimaera to grow in a water tank in the device. Although the water in the heater-cooler device does not come into contact with the patient’s blood, it is possible for the bacteria in contaminated water drops to become airborne and then settle on a patient during certain types of open heart surgery. Rarely, this may cause infection.

What are the chances that I have or will become infected?

It is important for you to understand that the chances of getting this infection are very low, estimated to be probably about 1 per 10,000 operations. We are not aware of any patients in South Australia who have developed this infection to date, though one case has been diagnosed in another state in Australia.  Patients undergoing surgery where a heart valve replacement or aorta replacement has been performed are more likely to be at risk of developing infection than surgeries where no prosthetic material was implanted (such as Coronary Artery Graft Surgery).

You may be at risk if:

a) you had open heart surgery that involves the insertion of prosthetic material, such as heart valves or aortic grafts, in Flinders Private Hospital within the past five years (between July 2011 and July 2016) where these heater-cooler devices were in use. 

AND b) you have or develop any of the symptoms listed below.

What are the symptoms of infection?

Signs of a possible M.chimaera infection may include:

  • unexplained fevers
  • unexplained weight loss 
  • increasing shortness of breath 
  • night sweats 
  • joint or muscle pains 
  • nausea, vomiting or abdominal pain 
  • pain, redness, heat or pus around the surgical site. 

What do I need to do next if I am at risk?

If you have one or more of these signs and symptoms and have had heart surgery within the past 5 years it is recommended that you make an appointment with your general practitioner for review and referral to your cardiac surgeon if necessary. As signs and symptoms are not limited to those listed above, it is important for you to speak to your General Practioner or Cardiac Surgeon if you are concerned.

What will happen to me?

Your doctor will conduct initial examinations. You may be referred to an Infectious Disease Physician for further assessment. Mycobacterium chimaera infections can be treated with antibiotics, but as the treatment is complicated they are only prescribed in patients with confirmed positive results.

What is SA Health doing about this problem?

All South Australian public and private hospitals that perform open heart surgery have undertaken a test of every heater-cooler device currently in use to determine if it has the bacterium. To date only the LivaNova (Sorin 3T) devices have had positive test results, and in these devices appropriate disinfection processes have been undertaken by the manufacturer, or the machines have been replaced.

All hospitals that use heater-cooler devices for open heart surgery have reviewed their maintenance procedures and ensured ongoing protocols are in line with the manufacturer’s recommendations.

What should I do to find out whether I am at risk?

Every patient who has had open heart surgery which may have involved the risk of infection using one of the affected devices in Flinders Private Hospital over the past 5 years will be contacted. Letters are expected to be delivered by early January 2017.

Is there a risk to my family and friends?

No, the Mycobacterium chimaera bacterium is not contagious. This means it cannot be spread from person to person through contact.

For more information
Communicable Disease Control Branch
11 Hindmarsh Square Adelaide SA 5000