Aortic Valve & Bypass - Questions on Basic Med Process

[Tedric]

Hoping Dr. Chien or other subject matter experts will have some suggestions/clarification for my scenario: Surgical replacement of aortic valve, and double bypass of blockages in LAD artery. No complications and smooth recovery after procedure. All indicators suggest a great outcome, and the benefit of catching this kind of thing relatively early before becoming symptomatic.

My questions have to do with special issuance under Basic Med, which would be required (as I understand it) for either of the conditions addressed in the surgery.

1. Is it 6 months after date of procedure that you can submit materials for the special issuance? 6 months to the day, or 6 calendar months?
2. Somewhere I recall seeing a PDF with a list of the 5 or 6 specific things the FAA would want in this submittal; pretty sure it was on the FAA website but for some reason I can't find it now. If someone can point me to the document/list that would be great.
3. At the 6 month mark, assume the necessary tests and reports are completed. Does the pilot then need to go through an AME for the special issuance submittal? A good idea even if not strictly required? Coordinate with the AME before lining up the testing and reports from the cardiologist?

Just a few details I've been curious about. Appreciate insight from the AME's and any pilots who've been there already.

Tedric

 

[Dana]

There is no "special issuance under Basic Med"; coronary heart disease requiring treatment or cardiac valve replacement invalidates you basicmed. To fly again (other than as sport pilot) you need a special issuance class 3 medical (from an AME, of course), after which you can drop back to basicmed.

 

[bbchien]

Tedrick
it's 6 months even for a transarterial valve.
Need: Admission note, operative note discharge summary. At >6 months after surgery and NOT A DAY SOONER, need: echo, rhythm monitor, Cardiologist's O.V. Treadmill no longer required.

And if you've ever had a special issuance from the agency before, all THAT stuff is needed, too....

B

 

[Tedric]

Thanks Dr. B, that helps. So if we assume procedure performed 3/28/25, then 9/29/25 would be first date to do the echo and rhythm monitor? Thoughts on whether having an AME in the loop is necessary or recommended?

 

[bbchien]

Yes to the above. Personally, I think it's a fool's errand to do this w/o the AME reviewing all yoru stuff, writing to the doc saying we need the following, after such and such a date, done in such and such a format.....etc. but YMMV.

O and I misread. You did have LAD blockages.
Add, you need the doc's cardiac cath dictation!
So you need a stress treadmill to 9 minutes' duration and to a max heart rate equal to at least 90% of (220-Your Age), I suggest the stress treadmill Echo (CPT 93350) as that's two chances to get around the 7% false positives on the EKG tracings alone. And you need all the tracings, too.

B

 

[Lindberg]

Thanks Dr. B, that helps. So if we assume procedure performed 3/28/25, then 9/29/25 would be first date to do the echo and rhythm monitor? Thoughts on whether having an AME in the loop is necessary or recommended?

You must have an AME involved because you're applying for a (minimum) third-class medical. Find a great Senior AME in your area who has experience with this stuff and can help you get everything in order before you apply.

 

[Tedric]

Very helpful, Dr. B, I will inquire as to local AMEs who are familiar with this process. I figured it cannot hurt to start out early in getting all the ducks in a row.

 

[Tedric]

Today's mail brought a 3rd class medical from the FAA home office. I'm very happy, as you can imagine.

Here's how my timeline worked out:
1. March 28, 2025: open heart surgery
2. July-September 2025: I did well recovering from surgery, and so in July began rounding up documentation, getting the required testing done, etc. Note that the FAA's Protocol for Cardiac Valve Replacement specifies a 6 month waiting period post-surgery for 1st and 2nd class applicants, but not for 3rd class. The separate Protocol for Coronary Heart Disease (3rd Class) does not have a fixed waiting period; it simply requires that your cardiologist have released you for normal activity, which per my cardiologist is typically 12 weeks post-op. I had to comply with both protocols due to having a double bypass along with the valve replacement. Copies of these protocols are attached. As you can see, they provide a detailed list of exactly what the FAA wants, and I worked hard to get everything right so that there would be no delays due to "hey, we need X and you didn't send it in."
3. Late September 2025: exam with AME, that was fine and together we worked to get all the stuff uploaded to FAA. The image files for echocardiogram and treadmill needed to go on a CD, which I sent via FedEx to the OKC office. Official submittal date was 10/3/2025.
4. Beginning sometime in December I checked the MedExpress website periodically. All it ever showed was that things were in the "transmittal" stage. I called a few times in January and February, and was told that it was actually in review, which suggested to me that someone had determined that they had all the materials they needed. But, I was still a bit apprehensive that I'd get the "we need X before we can proceed" letter, even though my gut feel was that I would have heard that within 2-3 months of submittal if it was going to happen.
5. March 2, 2026; checked MedExpress and lo and behold, it said there was a certification decision and a special issuance 3rd class had been approved.
6. March 9, 2026: 3rd class arrives in the mail, along with the usual letter explaining the FAA's review, decision, and various limiting factors and conditions as to what is needed to keep this in effect. The certificate is good only until October 31, 2026. Keeping it in effect will require annual submittal of a bunch of test data, cardiologist report, etc. I plan to move back to BasicMed after the certificate expires, so this won't be an issue for me, but it would be a somewhat burdensome process to go through every year - and I don 't know whether there is some expedited review process for those, so that you're not losing 5-6 months of your 12 month certificate just waiting for an answer.

So that's a quick overview of how all this worked out. I had ballparked 4-6 months for review, and that was about right.

For those who may be in a similar situation, my advice is to pay close attention to the protocol requirements. As an example, my cardiologist would have generated a pretty routine chart note after I saw him in September 2025, but that would have missed several specific items that the FAA wants to see in that report. I was prepared, though, and so we sat together and went through that list and made sure he addressed each item.

Hope this helps someone who ends up in the same path. Despite being grounded for just about a year, the end result is my cardiovascular health is greatly improved, I'm cleared to fly again, and I have a greater appreciation for how a medical issue can really throw a wrench into things - and that's just for a 3rd class hobby pilot like me, it would be a whole different thing if I flew for a living.

Thanks also to Dr. B for his thoughts early on.

John

 

[Jon Wilder]

There is no "special issuance under Basic Med"; coronary heart disease requiring treatment or cardiac valve replacement invalidates you basicmed. To fly again (other than as sport pilot) you need a special issuance class 3 medical (from an AME, of course), after which you can drop back to basicmed.

What he means is the one time SI medical he'll have to get in order to restore his BasicMed eligibility.

 

[Jon Wilder]

Today's mail brought a 3rd class medical from the FAA home office. I'm very happy, as you can imagine.

Here's how my timeline worked out:
1. March 28, 2025: open heart surgery
2. July-September 2025: I did well recovering from surgery, and so in July began rounding up documentation, getting the required testing done, etc. Note that the FAA's Protocol for Cardiac Valve Replacement specifies a 6 month waiting period post-surgery for 1st and 2nd class applicants, but not for 3rd class. The separate Protocol for Coronary Heart Disease (3rd Class) does not have a fixed waiting period; it simply requires that your cardiologist have released you for normal activity, which per my cardiologist is typically 12 weeks post-op. I had to comply with both protocols due to having a double bypass along with the valve replacement. Copies of these protocols are attached. As you can see, they provide a detailed list of exactly what the FAA wants, and I worked hard to get everything right so that there would be no delays due to "hey, we need X and you didn't send it in."
3. Late September 2025: exam with AME, that was fine and together we worked to get all the stuff uploaded to FAA. The image files for echocardiogram and treadmill needed to go on a CD, which I sent via FedEx to the OKC office. Official submittal date was 10/3/2025.
4. Beginning sometime in December I checked the MedExpress website periodically. All it ever showed was that things were in the "transmittal" stage. I called a few times in January and February, and was told that it was actually in review, which suggested to me that someone had determined that they had all the materials they needed. But, I was still a bit apprehensive that I'd get the "we need X before we can proceed" letter, even though my gut feel was that I would have heard that within 2-3 months of submittal if it was going to happen.
5. March 2, 2026; checked MedExpress and lo and behold, it said there was a certification decision and a special issuance 3rd class had been approved.
6. March 9, 2026: 3rd class arrives in the mail, along with the usual letter explaining the FAA's review, decision, and various limiting factors and conditions as to what is needed to keep this in effect. The certificate is good only until October 31, 2026. Keeping it in effect will require annual submittal of a bunch of test data, cardiologist report, etc. I plan to move back to BasicMed after the certificate expires, so this won't be an issue for me, but it would be a somewhat burdensome process to go through every year - and I don 't know whether there is some expedited review process for those, so that you're not losing 5-6 months of your 12 month certificate just waiting for an answer.

So that's a quick overview of how all this worked out. I had ballparked 4-6 months for review, and that was about right.

For those who may be in a similar situation, my advice is to pay close attention to the protocol requirements. As an example, my cardiologist would have generated a pretty routine chart note after I saw him in September 2025, but that would have missed several specific items that the FAA wants to see in that report. I was prepared, though, and so we sat together and went through that list and made sure he addressed each item.

Hope this helps someone who ends up in the same path. Despite being grounded for just about a year, the end result is my cardiovascular health is greatly improved, I'm cleared to fly again, and I have a greater appreciation for how a medical issue can really throw a wrench into things - and that's just for a 3rd class hobby pilot like me, it would be a whole different thing if I flew for a living.

Thanks also to Dr. B for his thoughts early on.

John

So now you can get your BasicMed back, and you would hold both a 3rd class medical certificate AND BasicMed until your 3rd class times out. You can continue on BasicMed and forego renewing the medical once the 3rd class times out. But...even though you'd have BasicMed, you are still obligated to comply with the terms of the Special Issuance Authorization until the medical certificate times out. Once the medical certificate times out, you can walk away from it.

 

[Tedric]

Right, perhaps I wasn't clear on this - when you need a special issuance, it has to be under the 1/2/3 class framework, its not a "BasicMed Special Issuance" because that animal does not exist. So I had been flying under BasicMed, then went into the 3rd class exam process to obtain a special issuance, and now once that expires in October I'll renew BasicMed and continue to fly under that.

 

[Bill]

Congrats, I love it when the good guys win! I'm now in year 13 of my momograft AVR replacement, so far no leakage and normal EF. Luckily my surgeon knew TAVR was on the horizion, and my "repair" supposedly was designed with using a TAVR valve replacement next time around.

 

[geezer]

There is a prize for meticulously following ALL the rules.

Tedric just won it. CONGRATULATIONS!

 

[Tedric]

Bill, that sounds somewhat similar to the thought process here. I’m 64 and my surgeon felt that at that age, and being otherwise in good health and a good surgical candidate, it was best to do the full blown surgery now and get a valve with (in his opinion) 20+ year lifespan, and permanent bypasses rather than stents for the blockages. Then, if I’m in my mid 80s and need a valve job, they can TAVR at that time, or whatever improved version of same is in use. Doing a TAVR now would give a shorter life expectancy valve, and a more complex surgical event later on when that needs replacing.

I wasn’t thrilled at the prospect of open heart surgery, but it was the right thing to do and I’m glad I bit the bullet and got it done.

 

[Jon Wilder]

Right, perhaps I wasn't clear on this - when you need a special issuance, it has to be under the 1/2/3 class framework, its not a "BasicMed Special Issuance" because that animal does not exist. So I had been flying under BasicMed, then went into the 3rd class exam process to obtain a special issuance, and now once that expires in October I'll renew BasicMed and continue to fly under that.

You were flying under Part 68 until the surgery, then had to obtain a one time SI under Part 67 before you were eligible to fly under Part 68 again.

 

[bbchien]

Congrats, and "welcome to the air".
B

 

[charosenz]

Today's mail brought a 3rd class medical from the FAA home office. I'm very happy, as you can imagine.

Here's how my timeline worked out:
1. March 28, 2025: open heart surgery
2. July-September 2025: I did well recovering from surgery, and so in July began rounding up documentation, getting the required testing done, etc. Note that the FAA's Protocol for Cardiac Valve Replacement specifies a 6 month waiting period post-surgery for 1st and 2nd class applicants, but not for 3rd class. The separate Protocol for Coronary Heart Disease (3rd Class) does not have a fixed waiting period; it simply requires that your cardiologist have released you for normal activity, which per my cardiologist is typically 12 weeks post-op. I had to comply with both protocols due to having a double bypass along with the valve replacement. Copies of these protocols are attached. As you can see, they provide a detailed list of exactly what the FAA wants, and I worked hard to get everything right so that there would be no delays due to "hey, we need X and you didn't send it in."
3. Late September 2025: exam with AME, that was fine and together we worked to get all the stuff uploaded to FAA. The image files for echocardiogram and treadmill needed to go on a CD, which I sent via FedEx to the OKC office. Official submittal date was 10/3/2025.
4. Beginning sometime in December I checked the MedExpress website periodically. All it ever showed was that things were in the "transmittal" stage. I called a few times in January and February, and was told that it was actually in review, which suggested to me that someone had determined that they had all the materials they needed. But, I was still a bit apprehensive that I'd get the "we need X before we can proceed" letter, even though my gut feel was that I would have heard that within 2-3 months of submittal if it was going to happen.
5. March 2, 2026; checked MedExpress and lo and behold, it said there was a certification decision and a special issuance 3rd class had been approved.
6. March 9, 2026: 3rd class arrives in the mail, along with the usual letter explaining the FAA's review, decision, and various limiting factors and conditions as to what is needed to keep this in effect. The certificate is good only until October 31, 2026. Keeping it in effect will require annual submittal of a bunch of test data, cardiologist report, etc. I plan to move back to BasicMed after the certificate expires, so this won't be an issue for me, but it would be a somewhat burdensome process to go through every year - and I don 't know whether there is some expedited review process for those, so that you're not losing 5-6 months of your 12 month certificate just waiting for an answer.

So that's a quick overview of how all this worked out. I had ballparked 4-6 months for review, and that was about right.

For those who may be in a similar situation, my advice is to pay close attention to the protocol requirements. As an example, my cardiologist would have generated a pretty routine chart note after I saw him in September 2025, but that would have missed several specific items that the FAA wants to see in that report. I was prepared, though, and so we sat together and went through that list and made sure he addressed each item.

Hope this helps someone who ends up in the same path. Despite being grounded for just about a year, the end result is my cardiovascular health is greatly improved, I'm cleared to fly again, and I have a greater appreciation for how a medical issue can really throw a wrench into things - and that's just for a 3rd class hobby pilot like me, it would be a whole different thing if I flew for a living.

Thanks also to Dr. B for his thoughts early on.

John

Outstanding for you and thanks for sharing!