Prosthetic Valves

Prosthetic valves can be mechanical or biological. There are a wide range of reported complications depending upon the variable methods of reporting, the make and model of the prosthesis, the site of implantation, comorbidities, and underlying left ventricular (LV) function, among other causes.

The clinical course is heavily influenced by factors other than valve-related complications, for example, LV dysfunction, congestive heart failure, progression of disease in other valves, coronary disease, or pulmonary hypertension.

Waiting period

Minimum — 3 months

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Is asymptomatic.
• Has clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.

Recommend not to certify if:

The driver has:

• Persistent symptoms.
• LV dysfunction (ejection fraction less than 40%).
• Thromboembolic complications post procedure.
• Atrial fibrillation.
• Pulmonary hypertension.
• Inadequate anticoagulation based on International Normalized Ratio (INR) checks at least monthly.

Monitoring/Testing

If treatment includes anticoagulant therapy, the driver should meet INR monitoring guidelines.

Echocardiography is indicated in the event of concerns about prosthetic valve dysfunction, perivalvular leaks, new murmurs, or LV function.

Exercise tolerance testing may be required to assess work capacity.

Follow-up

The driver should have an annual medical examination.

Valve Replacement Recommendation Table (PDF)