Guide for Aviation Medical Examiners

AASI for Single Valve Replacement or Repair

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

  • Authorization granted by the FAA
  • ECG - Required annually
  • Echo - Current 2D echocardiogram performed within 90 days
  • INRs for Mechanical Heart Values - A minimum of monthly International Normalized Ratio (INR) results for the immediate prior six months
  • Status report - performed within the past 90 days in accordance with the CHD Protocol


The AME must defer medical certification if the applicant has:

  • Additional valve procedure performed;
  • Any other disqualifying medical conditions or therapy not previously reported;
  • Any other reason for not renewing an AASI;
  • Arrhythmia, new onset, such as of atrial fibrillation/flutter, ventricular bigeminy, ventricular tachycardia, Mobitz Type II or greater AV block, complete heart block, RBBB, LBBB, or LVH
  • Bleeding that required medical intervention or other;
  • Echo reveals:
Any Valve Perivalvular leaking
Aortic Valve Area post procedure is less than 1.0 cm2
Peak gradient level is 60 mmHg or more
Mean gradient is 40 mmHg or more
Mitral Valve Any evidence of worsening of mitral valve regurgitation or stenosis in narrative
  • Emboli or thrombosis develop;
  • INR - More than 20% of INR values are less than 2.5 or greater than 3.5.
    • In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR values between 2.0 and 3.0 may be accepted (check with FAA);
  • New Event - Has another event, develops a new condition or identification of an additional cardiac condition not previously reported;
Last updated: Wednesday, August 25, 2021