MINI REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
The "Floating" Valve, a Modified Bioroot Bentall Procedure: A Narrative Review
1. McGill University, Montreal, Canada
2. McGill University Health Centre, Montreal, Canada
3. University College London, London, United Kingdom
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
With a rising incidence of aortic root disease globally, the Bentall procedure remains the gold standard for aortic root replacement. Unfortunately, the classic mechanical heart valves (MHVs) often employed in these surgeries require lifelong anticoagulation, carrying serious bleeding or thrombo-embolic risks and incurring significant lifestyle changes for patients. Recent advances have shifted focus towards biological heart valves (BHVs), leading to the emergence of a bioroot Bentall which can integrate a "floating" BHV within a synthetic vascular conduit. We reviewed contemporary evidence on this surgery to define indications, outcomes and knowledge gaps. This narrative review highlights surgical techniques, patient selection criteria, and surgical outcomes. Uniquely, "floating" valve placement improves hemodynamics and reduces prosthesis-patient mismatch. Additional advantages included valve-in-valve (ViV) feasibility and easier coronary re-access, while persisting barriers were uncertain long-term BHV durability and a lack of long-term randomized evidence. Emerging technologies, such as advanced biomaterials, and global demand for cardiac surgical care, are likely to further popularise this type of bioroot Bentall. Clinical preferences are shifting towards anticoagulation-free solutions, especially for younger, small-annulus, or anti-coagulation-averse patients. The "floating" bioroot Bentall is a compelling alternative to the use of traditional mechanical prostheses, offering a balance between durability and quality of life. Prospective registries and larger head-to-head trials are now required to benchmark floating bioroot Bentall on survival, valve durability, cost-effectiveness, and patient-reported outcomes. Future research should focus on optimizing BHV durability and refining surgical techniques to further improve clinical outcomes.
Summary
Keywords
Aortic root replacement, Bentall operation, Bioprosthetic valve, Prosthesis-patient mismatch, Valve degeneration
Received
03 December 2025
Accepted
13 February 2026
Copyright
© 2026 Derish, Lee, Hatzakorzian and Shum-Tim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: David Michael Derish; Dominique Shum-Tim
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.