Apico-Aortic Conduit for TAVR Failure

Abstract

Background: The apico-aortic conduit (AAC) has been described as a valid alternative in patients with extreme aortic calcifications or patent grafts below the sternum.

Case summary: A 54-year-old woman presented with progressive dyspnea 10 years after transcatheter aortic valve replacement (TAVR). Her prior surgical history included triple coronary artery bypass graft with both internal mammary arteries. Owing to a critically narrowed residual aortic root area observed on computed tomography, a beating-heart AAC procedure was performed.

Discussion: AAC has historically been proposed as a last-resort option in patients at prohibitive risk for conventional surgery. In our case, TAVR was first performed in a small aortic box. After the failure of this percutaneous approach, conventional surgical reintervention became prohibitive owing to massive aortic calcifications.

Take-home messages: When both conventional surgery and TAVR are not feasible, AAC may represent a viable choice. Before any percutaneous approach, emergent or lifetime bailout surgical strategies should be carefully planned.

Keywords: TAVR; aortic hypoplasia; aortic stenosis; apico-aortic conduit.