Native-Valve Transcatheter Aortic Valve Implantation for Late Apicoaortic Conduit Dysfunction

Objective: Apicoaortic conduit (AAC) surgery was historically performed for patients with severe aortic stenosis and hostile aortic anatomy. We report a case in which transcatheter aortic valve implantation (TAVI) on the native aortic valve restored effective antegrade outflow in a patient with late AAC dysfunction. Case Presentation: A 71-year-old woman who had undergone coronary artery bypass grafting and AAC surgery using a mechanical valve presented with progressive dyspnea and leg edema. Echocardiography revealed severe flow acceleration at the left ventricular-side AAC anastomosis, with a peak velocity of 6.2 m/s and a mean pressure gradient of 69 mmHg, whereas no significant acceleration or mechanical valve dysfunction was observed within the conduit itself. The native aortic valve also showed severe stenosis, with a mean gradient of 42.0 mmHg and markedly reduced antegrade flow. The heart team elected to perform TAVI on the native aortic valve to restore effective antegrade outflow. Following pre-dilation, a 26-mm Evolut FX+ self-expanding valve (Medtronic, Minneapolis, MN, USA) was successfully implanted. After TAVI, the native aortic valve mean gradient decreased to 7.9 mmHg, and the effective orifice area was 1.02 cm 2 . Estimated stroke volume through the AAC pathway decreased from 163 to 78.9 mL. The patient’s symptoms improved from New York Heart Association functional class III to I. Conclusion: TAVI for the native aortic valve can restore effective antegrade outflow and serve as a less invasive alternative to redo surgery for patients with late AAC dysfunction.