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

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.