(A) Tissue-engineered heart valves (TEHVs) (inset) were transapically delivered into the descending aorta (distal to the brachiocephalic trunk) and into the brachiocephalic trunk of adult sheep after creating native valve insufficiency by applying the Hufnagel procedure. (B) Contrast angiography displayed optimal positioning and normal function of the TEHV. (C) Post-mortem analysis confirmed positioning in the descending aorta distal to the brachiocephalic trunk. (D and E) Three-dimensional (3D) computed tomography reconstruction of the adult sheep heart (D and E showing anterior view, inset showing posterior view) with the self-expanding nitinol stent positioned in the descending aorta (‡) distal to the brachiocephalic trunk (*). (F to M) Transesophageal echocardiography (TEE) in the 2-dimensional (2D); (G and H), 2D color (I), and 3D (J to M) modes displayed the TEHV in the descending aorta (‡) above the native valve (*). In particular, the TEE analysis showed well-defined leaflets showing sufficient coaptation. There were no signs of pressure damage, leaflet rupture, or thrombus formation detectable. Also See Online Videos 1, 2, 3A, 3B, and 3C.