Leadless cardiac pacemakers (LPs) represent a significant advancement in cardiac pacing by eliminating the risks associated with traditional transvenous devices. Although single-chamber LPs have been in clinical use, the recent development of dual-chamber systems, such as AVEIR DR, offers synchronized atrial and ventricular pacing without the complications associated with transvenous hardware. Despite promising results, the widespread clinical adoption of dual-chamber LPs in Poland remains hindered by regulatory and reimbursement challenges. Although patients have access to single-chamber LPs, an unmet clinical need for dual-chamber LPs persists. Addressing this barrier is essential because dual-chamber LPs may optimize treatment by replacing two separate hospitalizations and implantations with a single procedure, thereby reducing the number of interventions and patient risk while lowering healthcare costs. This approach offers both clinical and economic benefits by improving efficiency and resource utilization in the healthcare system. This paper presents national experts' recommendations, supported by clinical research findings, on the use of dual-chamber LPs and solutions to increase their availability to patients in Poland.

Aortic valve repair (AVr) has evolved into a reproducible surgical strategy for selected patients with aortic regurgitation (AR), offering preservation of native tissue, avoidance of prosthesis-related complications, and favorable long-term outcomes when performed at expert centers. This narrative review summarizes contemporary concepts, indications, preoperative imaging work-up, and procedure selection for AVr in tricuspid (TAV) and bicuspid (BAV) aortic valves, with an emphasis on functional mechanisms and standardized annular and root stabilization. Recent international guidelines and key surgical series and registries addressing aortic valve repair, valve-sparing root replacement (VSRR), annuloplasty strategies, and bicuspid repair techniques were reviewed. Modern AVr is anchored in mechanism-based diagnosis of AR, systematic correction of cusp pathology, and stabilization of the functional aortic annulus (FAA), including the virtual basal ring, sinotubular junction, and aortic root. Current guideline recommendations support aortic valve repair in selected patients with severe AR at experienced centers when durable results are expected and recommend valve-sparing root replacement in young patients with aortic root dilation. Quantitative intraoperative quality control, including effective height targets, and durable annular stabilization are key determinants of repair longevity. AVr and VSRR represent mature surgical options for carefully selected patients with AR, particularly younger individuals with good cusp tissue and access to high-volume repair expertise. A mechanism-driven algorithm, including BAV-specific geometry restoration approaches such as the 180-degree reimplantation technique, may clarify the optimal procedure for each clinical scenario.