Careful monitoring is still required for decellularized donor aortic valves in terms of tailor-made medicine

Dear Editor, The single-centre retrospective study by Andreeva et al. [1] shows a lower mortality rate and higher freedom from valve-related adverse events in young patients who received decellularized aortic homografts (DAHs) versus mechanical composite valve grafts (MCVGs) up to 5 years after surgery. This study serving the needs of young patients undergoing aortic valve replacement (AVR) comes in front of previous data suggesting that mechanical valves may reduce patients’ postoperative life expectancy [2]. Thus, the authors should be congratulated for their dedicated study, as the clinical results presented are quite promising. However, certain aspects are yet not sufficiently addressed, e.g. the underlying disease that is indicative of reported procedures. MCVG implantation (vs isolated mechanical AVR) strongly suggests root dilatation or other sinus pathology. In contrast, standard DAH implantation involves full root technique, even if the primary pathology does not involve aortic sinus lesions. Likewise, the proportion of patients with preoperative predominant AV stenosis versus AV regurgitation remains unclear.