Los Angeles is one of the most congested travel centers in the world. LAX is one of the busiest airports in the world. Millions of people pass through LAX every year. For the people in southern California, air travel is part of their lifestyle. Whether it is a trip to San Francisco for the weekend, a trip across the country to visit family, or going on a trip overseas, air travel is routine. This brings me to a Westwood practice where I see patients that have undergone heart surgery. One of the very first practical questions that patients ask is something along the lines of: *When will I be able to fly?*

It is a very reasonable question. It is in fact a complicated question that is based on, one, the type of cardiac procedure you had. Two, on the type of procedure you had, how is your recovery going? Three, what specific risks are involved with flying that most people don’t think of until their surgeon mentions them? It is a complicated question and it is going to be very individualized to each person.

When going to the airport here are a few things every cardiac patient and their family members should know.

The Specific Risks: What Can Go Wrong

Before boarding a plane, it is important to know the specific risks that come with flying after a cardiac procedure. Understanding these risks will help the patient defend themselves from future problems.

DVT and Pulmonary Embolism

An immobility-related risk that is especially concerning for cardiac surgery patients is the development of Deep Vein Thrombosis (DVT) due to long-duration flights. Immobility can lead to the development of clots due to poor circulation. These clots form in the distal veins of the legs and can lead to the development of Pulmonary Embolism (PE) if a thrombus breaks free and travels to the lungs. PE can be fatal.

Inflammation from surgery increases the risk of thrombus formation in heart surgery patients, and long haul flights can lead to the formation of clots which are more likely to become dislodged during the flight.

Increased Cardiac Workload and Reduced Cabin O2 Levels

The body compensates for low oxygen availability in an airplane cabin by increasing the heart rate to deliver oxygen to tissues that is in demand. This is a a standard physiological response; however, in patients with heart failure or restricted coronary flow, this response may result in the development of symptoms.

Weeks following cardiac bypass surgery, patients have a reduced cardiac reserve, and the response to low cabin oxygen and resulting elevated heart rate demand is more than the heart is capable of and can be a severe complication.

Stress and Anxiety

Airports can be stressful places for anyone. Extreme wait times, security checks, sudden gate changes, and delays can cause frustration for any traveler. However, because of the increased stress hormones for cardiac patients, anxiety turns from being an emotional concern to being a serious issue. It can lead to an increased risk of heart function impairment, which could be dangerous for the patient.

Medication Timing and Time Zones

For patients on drugs like anticoagulants, antiarrhythmics, and beta-blockers, time zone crossings can pose serious risks. For cardiac patients, blood thinner doses must be jolted strictly and any time zone crossing or long plane rides can cause issues.

When Is It Safe to Fly? A Procedure-by-Procedure Guide

Depending on the type of cardiac surgery you had, the answer can be extremely different. Current clinical guidelines generally suggest a waiting period on the other end of the spectrum. It is a good idea to confirm with your surgeon before scheduling your travel plans.

Open Heart Surgery (CABG, Valve Replacement, Valve Repair)

Open heart surgery has the most intense procedures and will take the longest time to be cleared to fly again. Generally, it is suggested that air travel is avoided for at least 2-3 weeks after bypass surgery, and numerous surgeons will recommend to wait even longer for any international long-haul flights. The Civilian Aviation Authority have suggested the minimum time frame for air travel to be 10-14 days after any chest surgery or coronary artery bypass graft surgery.

For patients who had surgical complications, had extended hospital stays, or have other comorbidities like diabetes or kidney problems, the wait time is often increased more. Travel is cleared or approved only by the surgeon, who assesses the individual recovery.

Inserting a Stent (Coronary Angioplasty)

In comparison to open heart surgery, inserting a stent is much less invasive, therefore, the recovery time from being able to fly again is much shorter. Generally, patients can fly safely within 1-2 weeks after the stent is placed, assuming they remain stable, and obtain a clearance to travel from their cardiologist.

Heart Attack (Without Surgery)

If a patient suffers a heart attack, he/she/they can travel by plane only one week after clearance from the airline, and at best three to four weeks. If complications occurred, such as arrhythmias, large areas of heart tissue damage, or heart failure, then the waiting period is much longer. This must be done in coordination with the patient’s cardiologist.

Pacemaker or ICD Implantation

Patients with a pacemaker or ICD implantation are allowed to fly two to three days after the surgery, by what the practical aspect of the recovery period, is less than three to four weeks, and would have to manage the overhead and carry-on.

AFib Ablation

Patients with atrial fibrillation should not fly for one to two weeks after the ablation. It is also important to mention that alcohol can trigger AFib, and therefore, for people with this condition, it is not recommended to drink alcohol during the flight.

Tips for Traveling Safely After Heart Surgery

After clearance from the surgeon, Travelling can be as safe as possible.

Obtain written medical clearance. Obtaining medical clearance is a requirement by most airlines for individuals who have undergone cardiac procedures recently. Before booking a flight, speak with a cardiologist or surgeon for medical clearance letters, and document a medical clearance flight requirement. The National Health Service advises travelers with recent surgeries to consult with their airline because each airline has a unique post-surgical travel policy.

Medications should be kept in your carry-on bags, and should not be placed in checked baggage. It is important to carry more than the average amount, and medications should not be distilled into pill organizers, and should remain in their prescription bottles and clearly labeled. For patients who are travelling through multiple zones, the care team should be contacted to develop a dosing plan in advance. This plan should be performed in accordance with the clockwise rotation of the planet.

During the flight, you should be moving frequently. It is important to make a point to stand up and walk up and down the entire plane, and do ankle circles. Moving around is important to keep your legs from getting blood clots. Moving around is important to keep your blood from clotting. It is key for all cardiac patients not to consume alcohol. If compression stockings are needed, ensure you discuss this with your doctor prior to travel.

Staying well-hydrated is key. The air in the plane is hot and dry. There is a consistent need to drink water for the duration of the flight and to limit the dry-harsh air of the plane and to limit the harsh effects of dehydration. Do not consume alcohol, or caffeine.

Alert the TSA that you have a medical device If you have a pacemaker, internal cardiac defibrillator (ICD), or a ventricular assist device, you should have a doctor’s note and notify that TSA agent. Most scanners and metal detectors will not affect your device, however, it will make the process easier if they know.

Select your seat wisely. An aisle seat is a good option as you can get up and move without having to get over other people. Avoid window seats if you think you will need to get up a lot.

Make sure to plan ahead. When traveling with tight timelines, a cardiac patient may need to physically and mentally navigate through a lot of potentially stressful activities, including parking, check-in, security, and boarding, so they should plan accordingly to have that time.

Apply for a new position Locations that are high in elevation, such as Denver and Park City, as well as several international mountain cities, increase your cardiovascular demand, even with the airplane. If there is a high gain in elevation with a large increase in cardiovascular demand, make sure you consult with your cardiologist before you go.

There are certain situations where flying is not recommended for any period of time since surgery, including but not limited to the following:

– Uncontrolled heart failure or significant fluid retention

– Angina (unstable) or chest pain that occurs at rest

– Infection at the surgical site that is still active

– Recently significant arrhythmia that was recurrent, with active changes to your meds

– Recently unstable changes to your blood thinners (anticoagulation)

If any of these situations apply to you, please discuss them with your cardiologist before booking. When weighed against the possibility of a medical emergency at 35,000 feet over the Pacific, a postponed trip is certainly more desirable.