Transapical aortic valve implantation is a minimally invasive, beating-heart procedure that normally requires a general anesthetic. We herein report an 85-year-old patient with impaired pulmonary function who underwent successful transapical aortic valve implantation while awake, using a thoracic epidural anesthetic. (Ann Thorac Surg 2009;88:992-4) (C) 2009 by The Society of Thoracic Surgeons