# Apico-Aortic Conduit for TAVR Failure

## TL;DR

This case study explores the use of an apico-aortic conduit as a treatment option when TAVR and conventional surgery are not feasible due to severe aortic calcifications.

## Contribution

The paper presents a clinical case where an apico-aortic conduit was used as an alternative for patients with failed TAVR and prohibitive surgical risks.

## Key findings

- AAC was successfully used in a patient with extreme aortic calcifications after failed TAVR.
- AAC may serve as a viable option when both conventional surgery and TAVR are not feasible.
- Emergent surgical strategies should be planned before attempting percutaneous approaches in high-risk patients.

## Abstract

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

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.

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.

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.