Vascular and valvular therapies, consisting in vessel or valve replacement, represent today the most common surgical procedures in western countries. Since the first vessel and valve replacement in the 1950’s, the technology in that field has dramatically evolved over the last decades. Vessels and valves started to be replaced with rigid materials. Plastic tubes were used in vascular surgery while cage ball prostheses were used for heart valve replacement with more or less success. The drawbacks related to the rigidity of the material, not adapted to the human vascular flexible environment led surgeons and scientists to look for new flexible materials. Strong issues need however to be addressed by these materials: (1) long term durability, (2) biocompatibility, (3) tissue in growth must be allowed, (4) flexibility. Today, the characteristics of textiles seem to match these requirements. Textiles are unique materials in that they have low weight, high tensile strength and high flexibility. Among fibers available, one that has been already used most extensively in implants is polyester. It is biocompatible and resistant to degradation when in contact with body fluids. Polyester fabric has already been shown to be able to behave dynamically like a valve in vitro and in vivo in animal models. However, textile remains a challenging material as some friction occurs between filaments, which may jeopardize the device when used as valve or vessel material. Moreover, exaggerated tissue in growth in the textile porous structure may rigidify the fibrous construction and reduce its flexibility drastically. Despite these limits, textiles are good candidates, which can be used in the development of two major research fields related to vascular and valvular replacement devices: non invasive surgery and tissue engineering. While the non invasive approach in which patients are not exposed to the risks of surgery is highly suitable for an increasing elderly population, tissue engineering should allow in the future the reconstruction of native vessels and valves, which are able to grow with the patient. The rapid developments and success in percutaneous vascular stents implantation over the last 2 decades has made this technique attractive today even for the potential aortic valve replacement. But in any case of implantation some huge challenges remain especially due to the textile/stent interaction. As to the tissue engineering process, if some very promising results have been obtained in small vessel or heart valve geometry construction, the mechanical resistance of tissue generated organs is usually poor and depends highly on the textile scaffold properties. The biocompatibility with the implanted host is also a major concern. Some experience in the field led already to catastrophic inflammation results. Basically, some huge challenges remain before these innovative vascular and valvular surgery techniques become enough mature to replace open heart surgery.