Endoleak repair, severe cardiac dx

86yo male, for possible (open) fenestrated cuff repair to previous aortic stent graft due to endoleak.


  • IHD
    • AMI ’95, medical therapy since.
    • On aspirin/clopidogrel
    • Sestamibi (organised by vascular surgeons) shows large, fixed defect and no reversible ischaemia. EF 30-35%.
  • DCM due to above (EF 35%).
  • TIA 5yrs ago, no residual
  • EVAR 2018
  • RCRI 3-4 = elevated risk
  • DASI 7.5METS, chops wood!


  • Should surgery proceed?
    • Appeared well at F2F review and DASI very reassuring
    • Advanced age with multiple significant comorbidities – ABS data suggests 6yr life expectancy for the average 86yo Australian male
  • Is his heart failure optimised?
    • Discussed at cardiology meeting:
    • Biventricular pacing to improve EF? – unlikely to improve cardiac function in this patient. Indicated with wider QRS which is indicative of desynchrony.
    • Suggested addition of loop diuretic or spironolactone (doesn’t clinical appear overloaded)
    • Cardiologist opinion – patient has significant IHD with a substantial effect on his cardiac function. Recommended to reconsider surgery given high risk for poor perioperative outcome.


  • For further discussion with surgeon about risks/benefits from their perspective.