The patient after cardiac valve surgery--risks and complications

Nearly all forms of valve surgery are incompatible with fitness to fly. The biological valves have a small but definite thrombo-embolic risk and are prone to late failure. The prosthetic valves require long-term anticoagulant therapy and carry an unacceptable risk of thrombo-embolism. The only possible exception is the unmounted homograft in the aortic position. If two years after such a valve replacement a patient can be shown to have a normal resting electrocardiogram, a normal chest X-ray, a normal exercise stress test, a normal echocardiographic left ventricular chamber size and wall thickness and evidence of no significant gradient across the valve, consideration should be given to certification for multi-crew operation, subject to annual examination by a cardiologist. A satisfactory open mitral valvotomy with obliteration of the left atrial appendage in an airman in sinus rhythm might allow certification to fly 'as or with co-pilot', subject to strict annual review which should include clinical cardiological examination, echocardiography and exercise electrocardiography. Satisfactory conservative repair of the 'floppy' mitral valve with no clinical or echocardiographic evidence of significant residual mitral regurgitation may similarly allow a return to flying with a restricted licence .