To be honest, with new construction, a core drilling is not necessary either. There is a special stone with the ventilation pipe that is simply built in. There is no difference in work now. Ultimately, even with decentralized systems, a certain amount of planning cannot be avoided. Fans with heat recovery are always planned and connected in pairs, one ventilates inward, the other outward. If that doesn’t work out, there are also twin fans that handle both directions at once (no idea if that works well). They are definitely more expensive. What I find missing in the discussion are the outlets. In centralized controlled residential ventilation, they are usually planned in the ceiling. With decentralized systems, they are on the wall, and you cannot place furniture there. Ours in the bedroom conflicts somewhat with a wardrobe door; if you open it vigorously, the cover is closed. Of course, this can be avoided with good planning beforehand and knowing exactly where the furniture will go. But it is definitely a limitation.