The airline pilot after coronary artery bypass grafting

Abstract

The prognosis following coronary artery bypass grafting (CABG) is still being established in the long term. Graft-attrition occurs at a rate of 10% per annum in the first year, falling to 2-3% per annum in the second and subsequent years. Only 46% of symptomatic individuals treated surgically in one series were symptom-free at five years but newer surgical techniques may improve this figure. The risk of graft-atheroma increases with time as does the risk of atheroma in the native circulation. Nevertheless, sudden late cardiac death was not observed in the three to five year follow-up in the surgical group of the European Coronary Surgery Study Group. It is suggested that a pilot may be considered for certification for multi-crew operation 12 months after CABG, subject to the demonstration of a normal contrast ventriculogram, patent grafts without other significant disease, and a normal exercise electrocardiogram and exercise thallium 201 scan. Follow-up should be by six-monthly exercise electrocardiography and annual thallium scanning. A coronary angiogram should be performed not more than five years after recertification. The intermediate and long-term prognosis following percutaneous transluminal angioplasty is unknown.

Flying after heart surgery

“…The criteria for recertification following cardiac surgery have not changed substantially since the first UK workshop in aviation cardiology1 and have been substantiated by a CASS (coronary artery surgery study) data analysis looking at pilot equivalent cases and a US follow up of pilots 2-4. They are essentially the same following a myocardial infarct or coronary angioplasty.…”