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The "floating" valve, a modified bioroot Bentall procedure.

David Derish1,2, Oliver Sebastian Lee3, Roupen Hatzakorzian4

  • 1Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.

Frontiers in Cardiovascular Medicine
|March 30, 2026
PubMed
Summary

The floating bioroot Bentall procedure offers an anticoagulation-free alternative for aortic root replacement, improving hemodynamics and patient quality of life. Further research is needed to confirm long-term durability and outcomes.

Keywords:
Bentall operationaortic root replacementbioprosthetic valveprosthesis-patient mismatchsurgical innovationvalve degeneration

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Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Engineering
  • Medical Technology

Background:

  • Aortic root disease incidence is rising globally.
  • The traditional Bentall procedure with mechanical heart valves (MHVs) necessitates lifelong anticoagulation, posing risks.
  • Biological heart valves (BHVs) are emerging as alternatives, leading to the bioroot Bentall.

Purpose of the Study:

  • To review contemporary evidence on the "floating" bioroot Bentall procedure.
  • To define indications, outcomes, and knowledge gaps for this surgical approach.
  • To assess its potential as an anticoagulation-free solution for aortic root replacement.

Main Methods:

  • Narrative review of contemporary evidence.
  • Analysis of surgical techniques, patient selection, and outcomes.
  • Evaluation of "floating" valve placement advantages and limitations.

Main Results:

  • "Floating" BHV placement improves hemodynamics and reduces prosthesis-patient mismatch.
  • Advantages include valve-in-valve feasibility and easier coronary re-access.
  • Uncertainty regarding long-term BHV durability and lack of long-term randomized data remain barriers.

Conclusions:

  • The "floating" bioroot Bentall is a promising anticoagulation-free alternative to MHVs, balancing durability and quality of life.
  • It is particularly suitable for younger, small-annulus, or anticoagulation-averse patients.
  • Prospective registries and trials are required to benchmark its long-term survival, durability, cost-effectiveness, and patient-reported outcomes.