Heart valve replacement
What the FAA's documents say about heart valve replacement, in plain words, with the FAA's own words one press away.
FAA term: Cardiac Valve Replacement
- The AASI here is titled Single Valve Replacement or Repair; a repair of the mitral valve has its own FAA disposition table and CACI worksheet, and its own page.
- The AASI asks for a status report in accordance with the appropriate CHD Protocol, and those protocols have their own page.
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Single valve replacementA single valve replacement | Defers to the FAA | Special Issuance |
| Multiple valve replacementMore than one valve replaced | Defers to the FAA | FAA review |
Show the FAA's words: the FAA's table for Heart valve replacement
- Single valve replacement · Special Issuance
A single valve replacement -- tissue, mechanical or valvuloplasty -- for all classes. The page sends the examiner to the Cardiac Valve Replacement protocol. An initial Special Issuance requires an FAA decision, and follow-up Special Issuances go by the AASI protocol.
Single Valve Replacement (Tissue, Mechanical or Valvuloplasty) … All … See Cardiac Valve Replacement ( PDF ) … Initial Special Issuance – Requires FAA Decision Followup Special Issuance's – See AASI Protocol
- Multiple valve replacement · FAA review
A multiple valve replacement, for all classes. The protocol says applicants who have received multiple heart valve replacements may be considered. The page's evaluation data is to document the history and findings, the CVE Protocol, and to submit any tests deemed appropriate. It requires an FAA decision.
Multiple Valve Replacement … All … Document history and findings, CVE Protocol, and submit any tests deemed appropriate … Requires FAA Decision
Multiple heart valve replacement(s): Applicants who have received multiple heart valve replacements may be considered.
- A note on the table, 1
The protocol says the FAA may consider certification of all classes of applicants who have undergone a Ross Procedure (pulmonic valve transplanted to the aortic position and pulmonic valve replaced by a bioprosthesis), and that TAVR may also be considered for any class.
Ross Procedure: The FAA may consider certification of all classes of applicants who have undergone a Ross Procedure (pulmonic valve transplanted to the aortic position and pulmonic valve replaced by a bioprosthesis). … Transcatheter Aortic Valve Replacement (TAVR) Procedure: TAVR may also be considered for any class.
The FAA pathways for heart valve replacement
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateSingle valve replacement
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
- FAA reviewYour AME defers. The FAA decides.Multiple valve replacement
Which exam
Your step-by-step plan
Step 1: The recovery period
For first- and second-class applicants, 6 months after the procedure.First- or second-class applicants must have a 6-month recovery period after the procedure, to ensure stabilization.
Show the FAA's words: The recovery period
First- or Second-Class Applicants: Applicants may be reviewed by the Federal Air Surgeon's (FAS) Cardiology Panel or FAS Cardiology Consultant and must have a 6-month recovery period after procedure to ensure stabilization.
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 2: Hospital records of the valve replacement
Copies of all hospital and medical records of the replacement.Copies of all hospital and medical records of the valve replacement.
Including
- Admission history and physical (H&P)
- Discharge summary
- Operative report with the valve's make, model, serial number and size
- Pathology report
Show the FAA's words: Hospital records of the valve replacement
The following information must be submitted for all classes:
Copies of all hospital/medical records pertaining to the valve replacement:
Admission History & Physical (H&P);
Discharge summary;
Operative report with valve information (make, model, serial number and size); and
Pathology report
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 3: The treating cardiologist's report
The current status of the valve replacement.Report from your treating cardiologist
A current report from your treating cardiologist on the status of the valve replacement.
It should address
- Your general cardiovascular condition
- Any symptoms of valve or heart failure
- Any related abnormal physical findings
It must substantiate
- Satisfactory recovery and cardiac function
- Without evidence of embolic phenomena, significant arrhythmia, structural abnormality or ischemic disease
Warfarin report from the attending physician
If you are on warfarin (Jantoven).
If you are on warfarin (Jantoven).
If you are on warfarin (Jantoven): the attending physician confirms stability without complications.
The report includes
- Warfarin dose history and schedule
- INR values, monthly for the past 6 months, within acceptable range
Show the FAA's words: The treating cardiologist's report
A current report from the treating cardiologist regarding the status of the cardiac valve replacement. It should address your general cardiovascular condition, any symptoms of valve or heart failure, any related abnormal physical findings, and must substantiate satisfactory recovery and cardiac function without evidence of embolic phenomena, significant arrhythmia, structural abnormality, or ischemic disease.
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
If on warfarin (Jantoven), the attending physician must confirm stability without complications. Report must include warfarin (Jantoven) dose history, schedule, and International Normalized Ratio (INR) values (monthly for the past 6-month period of observation; must be within acceptable range).
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 4: Heart tests
A Holter, an echocardiogram, and any catheterization reports.24-hour Holter monitor
A current 24-hour Holter monitor evaluation, with select representative tracings.
Echocardiogram
A current M-mode, 2-dimensional and M-mode Doppler echocardiogram.
It includes
- Chamber dimensions
- Valvular gradients
The video of the study goes on CD-ROM, in DICOM compatible format.
Catheterization reports and films
If cardiac catheterization and coronary angiography have been performed.
If cardiac catheterization and coronary angiography have been performed.
If cardiac catheterization and coronary angiography were performed: all reports and films.
Including
- A copy of the cineangiogram on CD-ROM, in DICOM compatible format
Show the FAA's words: Heart tests
Current 24-hour Holter monitor evaluation to include select representative tracings.
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Current M-mode, 2-dimensional, and M-Mode Doppler echocardiogram, specifically including chamber dimensions and
valvular gradients. Submit the video resulting from this study on CD-ROM in DICOM compatible format.
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
If cardiac catheterization and coronary angiography have been performed, all reports AND films must be submitted, including a copy of the cineangiogram on CD-ROM in DICOM compatible format.
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 5: The CVE, for a multiple valve replacement
The cardiovascular evaluation the Item 36 page names for more than one valve replaced.For a multiple valve replacement.
Cardiology evaluation
For a multiple valve replacement.
The CVE's cardiology evaluation: a current, detailed progress note.
It includes
- History of any cardiac or co-morbid conditions
- Personal and family history, including premature heart disease
- Current medications, dosage and any side effects
- Cardiac and general physical exam findings
- Results of any testing
- Diagnosis
- Assessment and plan (prognosis)
- Follow-up
And specifically
- If there was a hospital stay or procedure, the events that led to the cardiac intervention or treatment
- Your functional capacity, and whether you have been cleared to return to regular activity
- Attempts to meet the guidelines for modifiable risk factors, such as lipid levels, aspirin, beta-blockers and stopping smoking
- The prognosis for incapacitation
CVE labs
Within 90 days before the examFor a multiple valve replacement.
Labs performed no more than 90 days before the exam.
The labs
- Hemoglobin A1c
- Blood lipid profile: total cholesterol, HDL, LDL and triglycerides
- Monthly INR readings, if you are on warfarin (Jantoven)
Show the FAA's words: The CVE, for a multiple valve replacement
An FAA CVE is comprised of Cardiology Evaluation + Lab Testing
Cardiology Evaluation should be submitted in the form of a current, detailed Clinical Progress Note and include: • A detailed summary of the history of any cardiac or co-morbid condition(s); • Personal and family medical history including premature heart disease; • Current medications, dosage, and side effects (if any); • Clinical cardiac and general physical exam findings; • Results of any testing performed; • Diagnosis; • Assessment and plan (prognosis); and • Follow-up. It must specifically include: • If hospitalization or procedure, include a summary of events that led to the cardiac intervention(s) or treatment; • A statement regarding the individual’s functional capacity and if they have been cleared to return to regular activity; • Attempts to meet the guidelines for modifiable risk factors (such as lipid levels, aspirin use, beta-blocker use, and smoking cessation per the American College of Cardiology and American Heart Association); and • Prognosis for incapacitation.
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Labs must be current (performed no more than 90 days before the AME exam) and include: • Hemoglobin A1c; • Blood lipid profile with total cholesterol, HDL, LDL, and triglycerides; and • INR monthly readings if on warfarin (Jantoven)
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Note: CVE does not include stress testing. See the corresponding disposition table or FAA letter to identity which type of stress test (if any) is required.
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 6: Sending it to the FAA
Everything in one mailing, with your full name and applicant ID.Everything goes to the FAA in one mailing. An Authorization cannot be considered until all the required data is received.
On every report
- Your full name and applicant ID
Also
- Keep a copy of everything you submit
- A medical release form may help in getting the information
Show the FAA's words: Sending it to the FAA
The applicant is responsible for providing all medical information required by the FAA to determine eligibility for medical certification. A medical release form may help in obtaining the necessary information. Authorization cannot be considered until all the required data has been received.
Use full name and applicant ID on any reports or correspondence. This will assist in locating the file.
Keep a copy of all documents and media submitted as a safeguard against loss.
Send all information in one mailing to either:
FAA source: Cardiac Valve Replacement Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Single valve replacementDefers to the FAASpecial Issuance
The page sends the examiner to the Cardiac Valve Replacement protocol. An initial Special Issuance requires an FAA decision, and follow-up Special Issuances go by the AASI protocol.
If the examiner defersMultiple valve replacementDefers to the FAAFAA review
The page's evaluation data is to document the history and findings, the CVE Protocol, and to submit any tests deemed appropriate. It requires an FAA decision.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Single valve replacement · Special Issuance
A single valve replacement -- tissue, mechanical or valvuloplasty -- for all classes. The page sends the examiner to the Cardiac Valve Replacement protocol. An initial Special Issuance requires an FAA decision, and follow-up Special Issuances go by the AASI protocol.
Single Valve Replacement (Tissue, Mechanical or Valvuloplasty) … All … See Cardiac Valve Replacement ( PDF ) … Initial Special Issuance – Requires FAA Decision Followup Special Issuance's – See AASI Protocol
- Multiple valve replacement · FAA review
A multiple valve replacement, for all classes. The protocol says applicants who have received multiple heart valve replacements may be considered. The page's evaluation data is to document the history and findings, the CVE Protocol, and to submit any tests deemed appropriate. It requires an FAA decision.
Multiple Valve Replacement … All … Document history and findings, CVE Protocol, and submit any tests deemed appropriate … Requires FAA Decision
Multiple heart valve replacement(s): Applicants who have received multiple heart valve replacements may be considered.
If the examiner defersSpecial Issuance
For a single valve replacement, the Item 36 page says an initial Special Issuance requires an FAA decision.
What the FAA lists to send
- Item 1. The protocol's information submitted for all classes: copies of all hospital and medical records of the valve replacement; a current report from the treating cardiologist; if on warfarin (Jantoven), the attending physician's confirmation of stability without complications; a current 24-hour Holter monitor evaluation; a current echocardiogram; and, if cardiac catheterization and coronary angiography have been performed, all reports and films.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
For a single valve replacement, the Item 36 page says an initial Special Issuance requires an FAA decision.
Single Valve Replacement (Tissue, Mechanical or Valvuloplasty) … All … See Cardiac Valve Replacement ( PDF ) … Initial Special Issuance – Requires FAA Decision
What the FAA lists to send
- Item 1
The protocol's information submitted for all classes: copies of all hospital and medical records of the valve replacement; a current report from the treating cardiologist; if on warfarin (Jantoven), the attending physician's confirmation of stability without complications; a current 24-hour Holter monitor evaluation; a current echocardiogram; and, if cardiac catheterization and coronary angiography have been performed, all reports and films.
The following information must be submitted for all classes: … Copies of all hospital/medical records pertaining to the valve replacement: … A current report from the treating cardiologist regarding the status of the cardiac valve replacement. … If on warfarin (Jantoven), the attending physician must confirm stability without complications. … Current 24-hour Holter monitor evaluation to include select representative tracings. … Current M-mode, 2-dimensional, and M-Mode Doppler echocardiogram, specifically including chamber dimensions and … If cardiac catheterization and coronary angiography have been performed, all reports AND films must be submitted,
After the FAA decides
AASIThe protocol says all classes may be eligible for an AASI Cardiac Valve Replacement, including TAVR or another single valve replacement, and the Item 36 page sends follow-up Special Issuances to the AASI protocol.
Show the FAA's words: after the FAA decides
All classes may be eligible for an AASI Cardiac Valve Replacement. … This includes TAVR or other SINGLE valve replacement.
Followup Special Issuance's – See AASI Protocol
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workGood to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Echo findings that stop a reissue
The AASI says the examiner may not issue if the echo shows perivalvular leaking at any valve; for the aortic valve, an area under 1.0 cm2 after the procedure, a peak gradient of 60 mmHg or more, or a mean gradient of 40 mmHg or more; or any worsening mitral regurgitation or stenosis in the narrative.
Show the FAA's words: good to know, 2
Echo reveals: … IF ANY OF THE FOLLOWING ARE NOTED ON ECHO, THE AME MAY NOT ISSUE. … Any Valve … Perivalvular leaking … Aortic Valve … Area post procedure is less than 1.0 cm 2 … Peak gradient level is 60 mmHg or more … Mean gradient is 40 mmHg or more … Mitral Valve … Any evidence of worsening of mitral valve regurgitation or stenosis in narrative
INR values that send a reissue to the FAA
The AASI has the examiner defer when more than 20% of INR values are below 2.5 or above 3.5. In select cases of a bileaflet (St. Jude) valve in the aortic position, values between 2.0 and 3.0 may be accepted (check with the FAA).
Show the FAA's words: good to know, 3
The AME must defer medical certification if the applicant has: … INR - 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);
A new valve since the Special Issuance
The protocol says that if there has been any new valve replacement since the Special Issuance, the examiner must defer. The AASI also has the examiner defer for an additional valve procedure.
Show the FAA's words: good to know, 4
If any new valve replacement since their Special Issuance, the AME must defer.
The AME must defer medical certification if the applicant has: … Additional valve procedure performed;
The first echo's video goes on a CD-ROM
For the first Special Issuance, the protocol asks for the video resulting from the echocardiogram on CD-ROM in DICOM compatible format, and a copy of any cineangiogram the same way.
Show the FAA's words: good to know, 5
Submit the video resulting from this study on CD-ROM in DICOM compatible format. … If cardiac catheterization and coronary angiography have been performed, all reports AND films must be submitted, including a copy of the cineangiogram on CD-ROM in DICOM compatible format.
The first AASI is deferred to the FAA
On a first-time application for the AASI, where the applicant has all the requisite medical information, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 6
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Cardiac Valve Replacement ProtocolOpen to print: Cardiac Valve Replacement Protocol, a PDF at the FAA, in a new tab
Special Issuance
- AASI – Cardiac Single Valve Replacement or Repair, third classOpen to print: AASI – Cardiac Single Valve Replacement or Repair, third class, a page at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Item 36 – Valvular DiseaseOpen to print: Item 36 – Valvular Disease, a page at the FAA, in a new tab
FAA review
- Open at the FAA: Cardiovascular Evaluation (CVE) Protocol, a PDF at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.