Mitral valve repair and replacement: requirements for certification to fly

Patients who have undergone mitral valve replacement with a mechanical pros thesis require life-long anticoagulation and, in spite of this, they have a n unacceptable stroke risk (1-3% per year). They are, therefore, unlikely t o be sufficiently fit for certification to fly. Patients undergoing mitral valve repair for either rheumatic or ischaemic mitral valve disease have a much higher risk of incapacitating event, or of death than is permissible f or certification. It is probable, however, that careful selection in patien ts who have had a mitral valve repair for degenerative mitral regurgitation , and who, (1) 6 months to a year after surgery remain in sinus rhythm, (2) have no more than trivial residual regurgitation and have good ventricular function, and (3) in whom the event-free survival is tolerable should prov ide some who are acceptable for restricted certification to By. Bearing in mind the positive reporting bias that inevitably exists within the literatu re, the current data support the cautious statement that such a group of pa tients can at present be identified. Patients who have undergone mitral val ve repair for degenerative mitral regurgitation should be considered for re stricted certification to fly, but only with careful review on a yearly bas is.