The airline pilot after coronary artery bypass grafting

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.