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Publications

Journal Article Consensus Statement Review Ppublish

PubMed: 42839649 DOI: 10.1093/icvts/ivag217

EACTS Expert Consensus Document on Civil Aviation Following Cardiothoracic Surgery and Transcatheter Procedures.

Interdiscip Cardiovasc Thorac Surg 41(10)

Authors: Thomas Syburra, Edward D Nicol, Carlos A Mestres, Milos Matkovic, Joanna d'Arcy, Denis Bron, Filip Casselman, Martin Czerny, Stephen Fremes, Norbert Guettler, Paul Philipp Heinisch, Stuart Mitchell, Joao Pedro Monteiro, John Pepper, Francesco Petrella, Ulrich Rosendahl, Barbara A Rosser, Dan Spiegelstein, Milan Milojevic

Affiliations

  • Division of Cardiac Surgery, Hôpital de La Tour, Meyrin/Geneva, Switzerland.
  • Aeromedical Center, Swiss Air Force, Dübendorf, Switzerland.
  • Departments of Cardiology and Radiology, Royal Brompton Hospital, London, United Kingdom.
  • Centre of Aviation Medicine, Royal Air Force, Henlow, United Kingdom.
  • Department of Cardiothoracic Surgery, The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa.
  • Department of Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia.
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Heart Center AZORG, Cluster Cardiovascular Surgery, Aalst, Belgium.
  • Department for Cardiac-,Thoracic-,Vascular Surgery and Aortic Medicine, University Heart Center Freiburg, Bad Krozingen, Germany.
  • Faculty of Medicine, Albert Ludwigs University Freiburg, University Hospital Freiburg, Freiburg, Germany.
  • Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada.
  • German Air Force Centre of Aerospace Medicine, Section Clinical Aviation Medicine, Cologne, Germany.
  • Medical Clinic I, Cardiology and Angiology, Justus Liebig University, Giessen, Germany.
  • Department of Congenital and Pediatric Heart Surgery, TUM University Hospital German Heart Center, Munich, Germany.
  • Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Europäisches Kinderherzzentrum München, Munich, Germany.
  • Heathrow Medical Services, Longford, West Drayton, Middlesex, United Kingdom.
  • Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Espinho, Portugal.
  • Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
  • Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
  • Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
  • National Heart and Lung Institute, Imperial College, London, United Kingdom.
  • Israel Air Force Aircrew Medical Unit, ELAL Israel Airlines, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Department of Cardiac Surgery and Cardiovascular Research, National Institute for Heart and Blood Vessels "Dedinje", Belgrade, Serbia.
  • Department of Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Abstract

Civil aviation medicine and cardiothoracic surgery intersect at a point where individual clinical outcomes and public safety are tightly coupled. Professional aircrew and other safety-critical aviation personnel must meet legally defined medical standards that are designed around an engineering approach to risk, including a low annual tolerance for sudden incapacitation, whereas passengers and cabin crew are exposed to the physiological constraints of the flight environment (hypobaric hypoxia, gas expansion, limited access to medical care, immobility, and circadian rhythm disruption). Yet, the evidence base guiding fitness-to-fly decisions after cardiothoracic procedures, treatment of aortic disease, and contemporary transcatheter interventions remains sparse and unevenly distributed across procedures, licensing classes, and operational contexts. This European Association of Cardio-Thoracic Surgery Expert Consensus Document appraises the available literature and synthesizes multidisciplinary expert knowledge to provide pragmatic, safety-oriented guidance for aeromedical examiners, treating clinicians, regulators, employers, and affected individuals. Focusing on civil aviation, it addresses return-to-duty considerations for professional aircrew and postoperative air-travel decisions for passengers. Key clinical and occupational determinants include procedure choice and durability, residual ischaemia or haemodynamic burden, arrhythmia risk, anticoagulation and device-related considerations, rehabilitation and surveillance testing, and, where appropriate, the role of operational restrictions such as multicrew limitations. Finally, it identifies key knowledge gaps and research priorities to support more consistent, evidence-based decision-making in this high-stakes setting.

MeSH

Safety, Air, Aviation