Objectives: Recently, we implanted an apicoaortic conduit off-pump in three high-risk patients with severe aortic stenosis. Methods: A muscle-coring device was utilized to create the apical outflow tract followed by insertion of a rigid apical connector. A valved conduit was then connected to the descending thoracic aorta and to the apical connector graft. Results: A stentless porcine bioprosthesis was implanted in two patients and a stented valve in one. The left ventricular (LV)-aortic gradients were reduced from a mean of 66 to 28 mmHg. Conclusions: With modification of an existing technique, apicoaortic conduit insertion can be performed safely off-pump. This technique can be applied to complex forms of LV outflow obstruction and high-risk patients.