Heart Valve Replacement - AASI : Further FAA Medical Workup

AASI Instructions for Airman and AME - 3rd Class Only

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide page 264, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

This Cardiac Valve Replacement AASI is presently restricted to the issue of a third-class airman medical certificate. First- and second-class applicants must be deferred to the FAA.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.

If this is a first time issuance of an Authorization for a cardiac valve replacement, and the applicant has all of the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

  • An Authorization granted by the FAA;
  • A current status report performed within the past 90 days in accordance with the CHD Protocol;
  • A current 2D echocardiogram performed within 90 days; and
  • For Mechanical Heart Values - A minimum of monthly International Normalized Ratio (INR) results for the immediate prior six months.

The AME must defer to the AMCD or Region if:

  • The airman requires another valve procedure;
  • Evidence of perivalvular leaking via echocardiogram;
  • The post procedure valve area is less than 1.0 cm2;
  • New onset arrhythmia such as of atrial fibrillation/flutter, ventricular bigeminy, ventricular tachycardia, Mobitz Type II or greater AV block, complete heart block, RBBB, LBBB or LVH (See Item 36. Heart);
  • More than 20% of INR values are less than 2.5 or greater than 3.5. In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR values between 2.0 and 3.0 may be accepted (check with FAA);
  • The applicant reports any other disqualifying medical condition or undergoes therapy not previously reported; or
  • The applicant develops emboli, thrombosis, bleeding that required medical intervention, or any other cardiac condition previously not diagnosed or reported.

Download an FAA AASI Cover sheet for the the submitting AME to use (2014 PDF format)