Editor,—The editorial “Flying after heart surgery”,1 is timely and focuses on an important aspect of rehabilitation. One might, however, question the validity of the statement that “Pilots may see cardiac surgery as their only hope...”. Furthermore, in attempting to explain “the 1% rule”, the defining point between professional fitness to fly on multicrew operations and permanent unfitness for duty, the authors' statements need some clarification.

The 1% rule2 requires that the cardiovascular mortality rate of an airman should not exceed 1% per annum, or approximately one event/one million hours. This attrition is approximately that of a 65 year old man in northern Europe and will be encumbered by additional non-fatal co-morbid, but potentially incapacitating, events. It …