Pilot licensing after aortic valve surgery.

Details

Serval ID
serval:BIB_680FAD3BDE5F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pilot licensing after aortic valve surgery.
Journal
Journal of Heart Valve Disease
Author(s)
Syburra Thomas, Schnueriger Hans, Kwiatkowski Barbara, Graves Kirk, Reuthebuch Oliver, Genoni Michele
ISSN
0966-8519[print], 0966-8519[linking]
Publication state
Published
Issued date
2010
Volume
19
Number
3
Pages
383-388
Language
english
Abstract
Background and aim of the study: Bicuspid aortic valve is the most common congenital heart malformation, and a high percentage of patients with this condition will develop complications over time. It is rare that pilots undergo aortic valve surgery, and the confirmation of flight-licensing requirements after aortic valve replacement (AVR) is a challenge for the patient's cardiac surgeon and, particularly, for the Aeromedical Examiner (AME). Only AMEs are able to determine the flight status of pilots. Furthermore, in military and in civil aviation (e.g., Red Bull Air Race), the high G-load environment experienced by pilots is an exceptional physiological parameter, which must be considered postoperatively.
Methods: A review was conducted of the aeronautical, surgical and medical literature, and of European pilot-licensing regulations. Case studies are also reported for two Swiss Air Force pilots.
Results: According to European legislation, pilots can return to flight duty from the sixth postoperative month, with the following limitations: that an aortic bioprosthesis presents no restrictions in cardiac function, requires no cardioactive medications, yet requires a flight operation with co-pilot, the avoidance of accelerations over +3 Gz and, in military aviation, restricts the pilot to non-ejection-seat aircraft. The patient follow up must include both echocardiographic and rhythm assessments every six months. Mechanical prostheses cannot be certified because the required anticoagulation therapy is a disqualifying condition for pilot licensing.
Conclusion: Pilot licensing after aortic valve surgery is possible, but with restrictions. The +Gz exposition is of concern in both military and civilian aviation (aerobatics). The choice of bioprosthesis type and size is determinant. Pericardial and stentless valves seem to show better flow characteristics under high-output conditions. Repetitive cardiological controls are mandatory for the early assessment of structural valve disease and rhythm disturbances. A pre-emptive timing is recommended when reoperation is indicated, without waiting for clinical manifestations of structural valve disease.
Keywords
Supraannular Porcine Bioprosthesis, Exercise Hemodynamics, Replacement, Stentless, Prosthesis, Guidelines, Management, Position, Disease, Force
Pubmed
Web of science
Create date
06/07/2010 9:46
Last modification date
20/08/2019 14:23
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