Apico-aortic conduit (AAC) which connects the left ventricular (LV) apex directly to the descending aorta through a valved conduit, is an alternative to surgical aortic valve replacement (AVR) for patients with aortic stenosis (AS) who are inoperable or high risk for surgical AVR and are not suitable candidates for transcatheter aortic valve implantation (TAVI).
An 84-year-old man with severe AS underwent an AAC combined with coronary artery bypass grafting 8 years earlier. A saphenous vein graft was anastomosed from the conduit to the left anterior descending artery. He had developed haemolytic anaemia requiring frequent blood transfusions. The stenosis at the anastomosis of the left ventricle and the conduit might be the cause of a turbulent flow and a shear stress which led to mechanical haemolysis. We expected that dilatation of native aortic valve would reduce the blood flow at the anastomosis site and thereby improve haemolytic anaemia. Since balloon aortic valvuloplasty improved haemolytic anaemia without exacerbation of myocardial ischaemia, transsubclavian TAVI was performed. After the TAVI, significant reductions in the pressure gradient between the left ventricle and the ascending aorta and that between the left ventricle and the conduit were achieved, and the patient remained clinically stable without the recurrence of haemolytic anaemia.