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Flying after heart surgery
  1. T TREASURE, Professor of Cardiothoracic Surgery
  1. Cardiothoracic Unit
  2. St George’s Hospital
  3. Blackshaw Road
  4. London SW17 0QT, UK
  5. Pilot KLM UK
  6. Ex CAA Senior Medical Officer
  7. Ex Consultant Surgeon
  8. Cuckfield, West Sussex, UK

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The discovery of significant cardiac disease in a pilot (or air traffic controller) results in the licensing authority temporarily removing his or her medical certificate, which automatically invalidates his or her pilot’s licence. (In the United Kingdom the “authority” is the Civil Aviation Authority (CAA) medical department, which is now using European-wide medical standards (Joint Aviation Requirements).) The return of this medical certificate may be very important—the professional pilot wishes to regain his livelihood, and the private pilot wishes to return to a much loved hobby. Pilots may see cardiac surgery as their only hope; therefore, it is important for all those involved in the decision whether to perform an operation, in particular the surgeon, to have some knowledge of the criteria that the CAA will use when considering recertification. (The criteria set out in this brief article reflect those set out in the workshops in aviation cardiology published as supplements to the European Heart Journal 1984, 1988, and 1992 rather than the personal opinions of the authors.)

1% rule

For over 20 years the CAA medical department has been advised on individual cases by its Medical Advisory Panel (MAP), a group of cardiologists and cardiac surgeons aware of aviation requirements. During this time a concept called the 1% rule has evolved. This starts with the recognition that any aeroplane system, including the pilot, has a failure rate that could lead to an accident. Statistically, a pilot incapacitation rate of one in one thousand million flying hours (1:1 000 000 000) maintains an “acceptable” overall aircraft failure/accident rate for commercial flying. This rate may seem small, but the aviation industry is highly safety conscious, and wishes to maintain its status as the safest way to travel (per distance covered).

A combination of MAP experience, aircraft simulator …

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