To fly as a pilot after cardiac surgery

Abstract

SummaryAircrew are responsible for safe and reliable aircraft operations. Cardiovascular disease accounts for 50% of all pilot licences declined or withdrawn for medical reasons in Western Europe and is the most common cases of sudden incapacitation in flight. Aircrew retirement age is increasing (up to age 65) in a growing number of airlines and the burden of subclinical, but potentially significant, coronary atherosclerosis is unknown in qualified pilots above age 40. Safety considerations are paramount in aviation medicine, and the most dreaded cardiovascular complications are thromboembolic events and rhythm disturbances due to their potential for sudden incapacitation. In aviation, the current consensus risk threshold for an acceptable level of controlled risk of acute incapacitation is 1% (for dual pilot commercial operations), a percentage calculated using engineering principles to ensure the incidence of a fatal air accident is no greater than 1 per 107 h of flying. This is known as the ‘1% safety rule’. To fly as a pilot after cardiac surgery is possible; however, special attention to perioperative planning is mandatory. Choice of procedure is crucial for license renewal. Licensing restrictions are likely to apply and the postoperative follow-up requires a tight scheduling. The cardiac surgeon should always liaise and communicate with the pilot’s aviation medicine examiner prior to and following cardiac surgery.

Contemporaneous management of valvular heart disease and aortopathy in aircrew

“…The requirement for licensing restrictions post-cardiac surgery also requires an understanding of the effect of the aviation environment on cardiac physiology and anatomy. 4 5 In those with arrhythmia, the risk of thromboembolic events must also be borne in mind, such as in those with atrial fibrillation (AF) secondary to VHD. For those with valve prostheses, embolic risk and arrhythmia remain an issue.…”

Non-coronary cardiac surgery and percutaneous cardiology procedures in aircrew

“…In military aviation, anticoagulation is often disqualifying, however, many civil regulations have become less strict in recent years, despite controversy regarding both bleeding and thrombosis risk. 6 8 Antiplatelet agents, such as aspirin and clopidogrel, are usually acceptable for flying duties.…”

“…Further detail on surgical considerations have recently been published 6 and requirements for follow-up after aortic valve surgery are listed in table 2 .…”

“… Adapted from Syburra 2018. 6 *Cardiac and aortic dimensions, and LV wall thickness may vary according to the body surface area and level of fitness, respectively. †On echocardiography.…”

“…Specific details with regards to cardiac surgical interventions (including coronary revascularisation) for pilots have recently been published and offer more technical detail for the cardiovascular surgeon. 6 …”