Human Ex Vivo Working-Heart Evaluation of Coronet-Framed Valve-Sparing Aortic Root Replacement.

BACKGROUND: Valve-sparing aortic root reconstruction (VSARR) requires durable annular stabilization and preservation of commissural geometry. Translational evaluation of stabilization platforms in anatomically authentic human tissue remains limited. OBJECTIVES: The authors aimed to evaluate the structural feasibility and qualitative functional performance of a coronet-framed annular stabilization platform during VSARR using an ex vivo human working-heart model. METHODS: Bench VSARR using a coronet-framed stabilization device was performed in a human heart explanted during orthotopic transplantation. Following reconstruction, the heart was mounted on a cardiopulmonary bypass-based ex vivo perfusion platform permitting transition from Langendorff reperfusion to a loaded working-heart configuration. Dynamic valve competence was additionally assessed using saline-filled endoscopic visualization. RESULTS: Bench reconstruction and device implantation were technically feasible and resulted in a geometrically stable root construct. Following reperfusion and repeated electrical defibrillation, intrinsic ventricular ejection was restored and maintained in a working-heart configuration with sustained coronary recirculation. Endoscopic assessment demonstrated preserved central leaflet coaptation without visible prolapse or commissural distortion under simulated loading conditions. CONCLUSIONS: An ex vivo human working-heart platform enabled translational structural and qualitative functional evaluation of a coronet-framed annular stabilization concept during VSARR using anatomically authentic human tissue.