Long-term durability and resilient tissue: ‘the future end of valve in valve!’

Current research focuses on new preservation technologies for xeno-pericardial prostheses with the aim of improving long-term durability, lowering the age threshold for bio-prosthetic valve implantation and thus reducing the side effects of long-lasting anticoagulation [1]. The increasing shift of an indicated age threshold for bio-prosthetic valve implantation towards younger patients may also lead to new long-term complementary treatment concepts, especially in times of success of the transcatheter aortic valve implantation (TAVI). We read with great interest the article ‘Final 5-year outcomes following aortic valve replacement with a RESILIA™ tissue bioprosthesis’ by Bartus et al., the authors present a prospective, non-randomized, single-arm study of 133 patients implanted with a RESILIA aortic with clinical outcomes and haemodynamic performance assessed annually for 5 years post-implant [2]. This study concluded that the bioprosthesis with RESILIA tissue demonstrated a good safety profile with excellent haemodynamic performance over 5 years of follow-up [3]. Aortic valve-in-valve is a less-invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. In this context, we present our reflection, if the long-term results on RESILIA tissue continue to be promising in the next studies, it could be legitimate to think of a RESILIA treatment on TAVI; this would change the paradigm by extinguishing the valve-in-valve approach in degenerative processes on surgical bio-prosthetic valves and TAVI. Conflict of interest: none declared.