A Heart for Flying: Peak Performance Essential for Airline Pilots

With hundreds of lives in their hands, peak performance is essential for airline pilots.

A Heart for Flying
Kethes Waram, MD, (left), performed a CrossBoss procedure on pilot Steve Courtoy, avoiding open heart surgery. Cardiologist John S. Raniolo, DO, (right) worked with John C. Lincoln Deer Valley Hospital to acquire the CrossBoss technology.

That's why the Federal Aviation Administration says pilots without excellent health cannot fly, not even with conditions deemed fine for others.

Southwest Airlines Captain Steve Courtoy's heart is a perfect example.

His symptoms felt like heartburn and pressure. Tests showed his right coronary artery (RCA) had a chronic total occlusion. This usually requires surgery to bypass the blockage. But in Steve's case, tiny arteries developed to reroute blood to the RCA past the total occlusion. This natural bypass was good, but not enough to prevent symptoms.

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For many people, symptoms would be managed with medication. FAA medical standards are stratospherically more stringent, reassuring for the public, challenging for pilots.

When Steve's problem developed, the FAA required the pilot to remain grounded for six months, then pass a nuclear treadmill stress test and undergo a post-event cardiac catherization. Test results are presented to the Federal Air Surgeon's Cardiology Panel.

If the cardiology panel decides the pilot meets its standards, it grants a waiver and the pilot can resume flying. The FAA denied Steve's waiver because his RCA was still blocked. It didn't matter that his heart had made its own bypass.

"The FAA said I was 'a threat to aviation safety,' and I could not re-apply for a medical waiver unless a significant change to my health status occurred," Steve said. For a former military fighter jock and current airline captain, this was really bad news.

Surgery Alternative

"I didn't want open heart surgery, so I looked for other options," he said.

Steve identified the few cardiologists around the country who could solve his problem without "cracking his chest." Although he was in Tennessee, he called them all. "Dr. Raniolo called me back within 10 minutes."

CrossBoss and Stingray

Kethes Waram, MD, trained on CrossBoss during his interventional cardiology fellowship, is among the few Arizona specialists who can perform the procedure.

If CrossBoss cannot get through the occlusion, the device may slide between layers of the blood vessel and guide a wire around the blockage.

If that occurs, StingRay can redirect the wire back into the blood vessel beyond the blockage.

Phoenix cardiologist John S. Raniolo, DO, a senior aviation medical examiner, is a member of the Federal Air Surgeon's Cardiology Panel that reviews pilot heart health and makes recommendations regarding their medical certification. Better than most of his cardiology colleagues, he understands what it takes to be qualified to fly.

Dr. Raniolo and his colleagues at Southwest Cardiology (no relation to Southwest Airlines) recently worked with John C. Lincoln Deer Valley Hospital to acquire Boston Scientific's CrossBoss and StingRay interventional coronary artery technology.

CrossBoss is a blunt device that travels via catheter to a chronic total occlusion. It can dissect and deliver a wire through a blockage such as the one in Steve's RCA, said Dr. Raniolo's colleague, Kethes Waram, MD. The wire guides a stent into position to hold the artery open.

Inside the Deer Valley Hospital Cath Lab, Dr. Waram cleared the blockage and restored blood flow, leading to flight-worthy results on post-procedural heart tests, symptomatic relief and probable extended life span.

"Through the power of prayer, Dr. Waram's knowledge and steady hands, this procedure resulted in zero complications and zero blockage," Steve said. "We are very grateful to all involved – and thankful for the opportunity to return to fly."

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